Provider Demographics
NPI:1477681997
Name:JOHNSON COUNTY NURSING HOME, INC.
Entity Type:Organization
Organization Name:JOHNSON COUNTY NURSING HOME, INC.
Other - Org Name:JOHNSON COUNTY HEALTH & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCIAL REPORTING
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-621-2100
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:GA
Mailing Address - Zip Code:31002-0287
Mailing Address - Country:US
Mailing Address - Phone:478-668-3225
Mailing Address - Fax:478-668-3927
Practice Address - Street 1:1 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:GA
Practice Address - Zip Code:31002
Practice Address - Country:US
Practice Address - Phone:478-668-3225
Practice Address - Fax:478-668-3927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-083-1775261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00141644EMedicaid