Provider Demographics
NPI:1093751976
Name:WINTHROP MANOR NURSING HOME LLC
Entity Type:Organization
Organization Name:WINTHROP MANOR NURSING HOME LLC
Other - Org Name:WINTHROP HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRIOS TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-235-1422
Mailing Address - Street 1:12 CHATEAU DR SE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-7237
Mailing Address - Country:US
Mailing Address - Phone:706-235-1422
Mailing Address - Fax:706-236-9247
Practice Address - Street 1:12 CHATEAU DR SE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-7237
Practice Address - Country:US
Practice Address - Phone:706-235-1422
Practice Address - Fax:706-236-9247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-057-1727314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000143118AMedicaid
51000442 001OtherBCBS
51000442 001OtherBCBS