Provider Demographics
NPI:1134511975
Name:3223 FALLIGANT AVENUE ASSOCIATES, L.P.
Entity Type:Organization
Organization Name:3223 FALLIGANT AVENUE ASSOCIATES, L.P.
Other - Org Name:THUNDERBOLT TRANSITIONAL CARE AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-992-0441
Mailing Address - Street 1:3223 FALLIGANT AVE
Mailing Address - Street 2:
Mailing Address - City:THUNDERBOLT
Mailing Address - State:GA
Mailing Address - Zip Code:31404-5339
Mailing Address - Country:US
Mailing Address - Phone:912-691-2512
Mailing Address - Fax:912-353-9353
Practice Address - Street 1:3223 FALLIGANT AVE
Practice Address - Street 2:
Practice Address - City:THUNDERBOLT
Practice Address - State:GA
Practice Address - Zip Code:31404-5339
Practice Address - Country:US
Practice Address - Phone:912-691-2512
Practice Address - Fax:912-353-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
115624Medicare Oscar/Certification