Provider Demographics
NPI:1407908155
Name:ADK THOMASVILLE OPERATOR, LLC
Entity Type:Organization
Organization Name:ADK THOMASVILLE OPERATOR, LLC
Other - Org Name:THOMASVILLE NURSING AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP MIS
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:GROEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-964-8974
Mailing Address - Street 1:120 SKYLINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31757-2507
Mailing Address - Country:US
Mailing Address - Phone:229-225-1049
Mailing Address - Fax:229-225-1017
Practice Address - Street 1:120 SKYLINE DRIVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757-2507
Practice Address - Country:US
Practice Address - Phone:229-225-1049
Practice Address - Fax:229-225-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11361886314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00277604AMedicaid
GA00277604AMedicaid