Provider Demographics
NPI:1275514259
Name:RANDOLPH COUNTY HEALTH AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:RANDOLPH COUNTY HEALTH AND REHABILITATION, LLC
Other - Org Name:JOE-ANNE BURGIN HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-732-2288
Mailing Address - Street 1:321 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:CUTHBERT
Mailing Address - State:GA
Mailing Address - Zip Code:39840-6127
Mailing Address - Country:US
Mailing Address - Phone:229-732-2288
Mailing Address - Fax:229-732-2382
Practice Address - Street 1:321 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:CUTHBERT
Practice Address - State:GA
Practice Address - Zip Code:39840-6127
Practice Address - Country:US
Practice Address - Phone:229-732-2288
Practice Address - Fax:229-732-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00141633AMedicaid
GA115272Medicare ID - Type Unspecified