Provider Demographics
NPI:1598731515
Name:BARTOW COUNTY HEALTH CARE CENTER, INC
Entity Type:Organization
Organization Name:BARTOW COUNTY HEALTH CARE CENTER, INC
Other - Org Name:MAPLE RIDGE HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KARSCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-939-8720
Mailing Address - Street 1:22 MAPLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-2228
Mailing Address - Country:US
Mailing Address - Phone:770-606-8800
Mailing Address - Fax:770-606-1112
Practice Address - Street 1:22 MAPLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-2228
Practice Address - Country:US
Practice Address - Phone:770-606-8800
Practice Address - Fax:770-606-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10081552314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00534619AMedicaid
GA115543Medicare ID - Type Unspecified