Provider Demographics
NPI:1235175126
Name:BALDWIN COUNTY NURSING HOME LLC
Entity Type:Organization
Organization Name:BALDWIN COUNTY NURSING HOME LLC
Other - Org Name:GREEN ACRES HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOODWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-453-9437
Mailing Address - Street 1:313 ALLEN MEMORIAL DR SW
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-4405
Mailing Address - Country:US
Mailing Address - Phone:478-453-9437
Mailing Address - Fax:478-452-7191
Practice Address - Street 1:313 ALLEN MEMORIAL DR SW
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-4405
Practice Address - Country:US
Practice Address - Phone:478-453-9437
Practice Address - Fax:478-452-7191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-005-1783314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
51004446 001OtherBCBS
GA00083014AMedicaid
GA00083014AMedicaid