Provider Demographics
NPI:1497728505
Name:MOLENA HEALTH & REHAB, LLC.
Entity Type:Organization
Organization Name:MOLENA HEALTH & REHAB, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-884-5138
Mailing Address - Street 1:185 HILL ST
Mailing Address - Street 2:
Mailing Address - City:MOLENA
Mailing Address - State:GA
Mailing Address - Zip Code:30258-3115
Mailing Address - Country:US
Mailing Address - Phone:770-884-5138
Mailing Address - Fax:770-884-5484
Practice Address - Street 1:185 HILL ST
Practice Address - Street 2:
Practice Address - City:MOLENA
Practice Address - State:GA
Practice Address - Zip Code:30258-3115
Practice Address - Country:US
Practice Address - Phone:770-884-5138
Practice Address - Fax:770-884-5484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-114-1948314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000142029AMedicaid
GA11-5693Medicare ID - Type Unspecified