Provider Demographics
NPI:1407968415
Name:THE COBB FOUNDATION, INC
Entity Type:Organization
Organization Name:THE COBB FOUNDATION, INC
Other - Org Name:HARTWELL HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAFTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-856-6159
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-0280
Mailing Address - Country:US
Mailing Address - Phone:706-856-6100
Mailing Address - Fax:706-856-6117
Practice Address - Street 1:94 CADE ST
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-1814
Practice Address - Country:US
Practice Address - Phone:706-856-6991
Practice Address - Fax:706-856-5985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-073-1546314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00141413AMedicaid
GA00141413AMedicaid