Provider Demographics
NPI:1558357368
Name:MARIETTA HEALTH AND REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:MARIETTA HEALTH AND REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:FALLAW
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:229-268-7510
Mailing Address - Street 1:50 SAINE DR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-3824
Mailing Address - Country:US
Mailing Address - Phone:770-429-8600
Mailing Address - Fax:770-429-8677
Practice Address - Street 1:50 SAINE DR SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-3824
Practice Address - Country:US
Practice Address - Phone:770-429-8600
Practice Address - Fax:770-429-8677
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROEALTH RESOURCE GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-27
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-033-1793314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00202507AMedicaid
GA115276Medicare Oscar/Certification