Provider Demographics
NPI:1447775655
Name:MACON OPERATING LLC
Entity Type:Organization
Organization Name:MACON OPERATING LLC
Other - Org Name:FOUNTAIN BLUE REHAB AND NURSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MENDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRECHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-484-8888
Mailing Address - Street 1:5308 13TH AVE STE 273
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3804
Mailing Address - Country:US
Mailing Address - Phone:718-484-8888
Mailing Address - Fax:
Practice Address - Street 1:3051 WHITESIDE RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-6209
Practice Address - Country:US
Practice Address - Phone:478-788-1421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility