Provider Demographics
NPI:1407375645
Name:GLOBAL ABBEVILLE, LLC
Entity Type:Organization
Organization Name:GLOBAL ABBEVILLE, LLC
Other - Org Name:GLEN EAGLE HEALTHCARE AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-635-4085
Mailing Address - Street 1:206 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31001-4216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:206 MAIN ST E
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31001-4216
Practice Address - Country:US
Practice Address - Phone:229-467-2515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003214231AMedicaid