Provider Demographics
NPI:1255494894
Name:NATIONAL ASSISTANCE BUREAU, INC.
Entity Type:Organization
Organization Name:NATIONAL ASSISTANCE BUREAU, INC.
Other - Org Name:GALLAWAY HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TYGH
Authorized Official - Middle Name:
Authorized Official - Last Name:BROGDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-650-8773
Mailing Address - Street 1:1145 HEMBREE RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1122
Mailing Address - Country:US
Mailing Address - Phone:770-650-8773
Mailing Address - Fax:770-650-9732
Practice Address - Street 1:435 OLD BROWNSVILLE ROAD
Practice Address - Street 2:GALLAWAY HEALTHCARE CENTER
Practice Address - City:GALLAWAY
Practice Address - State:TN
Practice Address - Zip Code:38036
Practice Address - Country:US
Practice Address - Phone:901-867-8575
Practice Address - Fax:901-867-2598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000077314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445440Medicaid
TN0445440Medicaid