Provider Demographics
NPI:1578579165
Name:BROOKWOOD-MADISON COUNTY CONVALESCENT CENTER LLP
Entity Type:Organization
Organization Name:BROOKWOOD-MADISON COUNTY CONVALESCENT CENTER LLP
Other - Org Name:MADISON MANOR NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIEZENTANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-689-5200
Mailing Address - Street 1:345 MANOR RD
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28754-7606
Mailing Address - Country:US
Mailing Address - Phone:828-689-5200
Mailing Address - Fax:828-689-2729
Practice Address - Street 1:345 MANOR RD
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:NC
Practice Address - Zip Code:28754-7606
Practice Address - Country:US
Practice Address - Phone:828-689-5200
Practice Address - Fax:828-689-2729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0387870001OtherDMERC
NCNH0290OtherDFS LICENSE
NC3405206Medicaid
NC3406224Medicaid
NC345206Medicare ID - Type UnspecifiedMEDICARE