Provider Demographics
NPI:1518040351
Name:ADK SAVANNAH BEACH OPERATOR, LLC
Entity Type:Organization
Organization Name:ADK SAVANNAH BEACH OPERATOR, LLC
Other - Org Name:SAVANNAH BEACH NURSING & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/MIS
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:GROEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-964-8974
Mailing Address - Street 1:PO BOX 2509
Mailing Address - Street 2:
Mailing Address - City:TYBEE ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31328-2509
Mailing Address - Country:US
Mailing Address - Phone:912-786-4511
Mailing Address - Fax:912-786-7414
Practice Address - Street 1:26 VAN HORN
Practice Address - Street 2:
Practice Address - City:TYBEE ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31328-9726
Practice Address - Country:US
Practice Address - Phone:912-786-4511
Practice Address - Fax:912-786-7414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-0251697314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000142876AMedicaid
GA115633Medicare Oscar/Certification