Provider Demographics
NPI:1326037516
Name:ELBERTA HEALTHCARE, LLC
Entity Type:Organization
Organization Name:ELBERTA HEALTHCARE, LLC
Other - Org Name:SOUTHERN PINES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-328-3800
Mailing Address - Street 1:801 ELBERTA RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-1735
Mailing Address - Country:US
Mailing Address - Phone:478-923-3146
Mailing Address - Fax:478-922-9145
Practice Address - Street 1:801 ELBERTA RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-1735
Practice Address - Country:US
Practice Address - Phone:478-923-3146
Practice Address - Fax:478-922-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-076-1674314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00140918AMedicaid
GA00140918AMedicaid