Provider Demographics
NPI:1336138528
Name:EASTVIEW HEALTHCARE, LLC
Entity Type:Organization
Organization Name:EASTVIEW HEALTHCARE, LLC
Other - Org Name:EASTVIEW NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATOR
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 1:3020 JEFFERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-5118
Mailing Address - Country:US
Mailing Address - Phone:478-746-3547
Mailing Address - Fax:478-750-9451
Practice Address - Street 1:3020 JEFFERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-5118
Practice Address - Country:US
Practice Address - Phone:478-746-3547
Practice Address - Fax:478-750-9451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-011-1675314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00140885AMedicaid
GA115656Medicare ID - Type UnspecifiedPROVIDER NUMBER
GA00140885AMedicaid