Provider Demographics
NPI:1437188646
Name:TOWNSEND PARK HEALTH AND REHABILITATION LLC
Entity Type:Organization
Organization Name:TOWNSEND PARK HEALTH AND REHABILITATION LLC
Other - Org Name:TOWNSEND PARK HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-387-0662
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-1682
Mailing Address - Country:US
Mailing Address - Phone:770-387-0662
Mailing Address - Fax:770-382-6080
Practice Address - Street 1:196 N DIXIE AVE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3343
Practice Address - Country:US
Practice Address - Phone:770-387-0662
Practice Address - Fax:770-382-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-008-1231314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
51266606 001OtherBCBS
GA000404995AMedicaid
115461Medicare Oscar/Certification