Provider Demographics
NPI:1558308692
Name:TOOMBS NURSING HOME LLC
Entity Type:Organization
Organization Name:TOOMBS NURSING HOME LLC
Other - Org Name:OXLEY PARK HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-526-6336
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:GA
Mailing Address - Zip Code:30436-0352
Mailing Address - Country:US
Mailing Address - Phone:912-526-6336
Mailing Address - Fax:912-526-3290
Practice Address - Street 1:181 OXLEY DR
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:GA
Practice Address - Zip Code:30436-5644
Practice Address - Country:US
Practice Address - Phone:912-526-6336
Practice Address - Fax:912-526-3290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-097-1672314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00143316AMedicaid
51053899 001OtherBCBS
GA00143316AMedicaid