Provider Demographics
NPI:1558318337
Name:LANIER HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:LANIER HEALTH SERVICES, INC
Other - Org Name:LAKELAND VILLA & CONVALESCENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:W
Authorized Official - Last Name:GINTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-482-8402
Mailing Address - Street 1:852 W THIGPEN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:GA
Mailing Address - Zip Code:31635-1006
Mailing Address - Country:US
Mailing Address - Phone:229-482-3110
Mailing Address - Fax:229-482-8542
Practice Address - Street 1:852 W THIGPEN AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:GA
Practice Address - Zip Code:31635-1006
Practice Address - Country:US
Practice Address - Phone:229-482-3110
Practice Address - Fax:229-482-8542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10861322313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00141732AMedicaid
GA00141732AMedicaid