Provider Demographics
NPI:1033180567
Name:MEDICAL MANAGEMENT HEALTH & REHAB CENTER LLC
Entity Type:Organization
Organization Name:MEDICAL MANAGEMENT HEALTH & REHAB CENTER LLC
Other - Org Name:MEDICAL MANAGEMENT HEALTH AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WINGET
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:478-974-0006
Mailing Address - Street 1:1509 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204
Mailing Address - Country:US
Mailing Address - Phone:478-743-4678
Mailing Address - Fax:478-738-0250
Practice Address - Street 1:1509 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204
Practice Address - Country:US
Practice Address - Phone:478-743-4678
Practice Address - Fax:478-738-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-011-1824314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00141941AMedicaid
GA00141941AMedicaid