Provider Demographics
NPI:1568631521
Name:MARSH'S EDGE, LLC
Entity Type:Organization
Organization Name:MARSH'S EDGE, LLC
Other - Org Name:MARSH'S EDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:O
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-246-1616
Mailing Address - Street 1:111 RENEGAR WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-8840
Mailing Address - Country:US
Mailing Address - Phone:912-291-2038
Mailing Address - Fax:
Practice Address - Street 1:111 RENEGAR WAY
Practice Address - Street 2:
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-8840
Practice Address - Country:US
Practice Address - Phone:912-291-2038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA115718Medicare Oscar/Certification