Provider Demographics
NPI:1437144854
Name:AZALEALAND MANAGEMENT INC
Entity Type:Organization
Organization Name:AZALEALAND MANAGEMENT INC
Other - Org Name:AZALEALAND NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-354-2752
Mailing Address - Street 1:2040 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2226
Mailing Address - Country:US
Mailing Address - Phone:912-354-2752
Mailing Address - Fax:912-352-2038
Practice Address - Street 1:2040 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2226
Practice Address - Country:US
Practice Address - Phone:912-354-2752
Practice Address - Fax:912-352-2038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-025-1060314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00141237AMedicaid
GA00141237AMedicaid
GA0716240001Medicare ID - Type UnspecifiedMEDICARE PART B