Provider Demographics
NPI:1629441167
Name:FRANKLIN HEALTHCARE OF MADISONVILLE, LLC
Entity Type:Organization
Organization Name:FRANKLIN HEALTHCARE OF MADISONVILLE, LLC
Other - Org Name:RIVERWOOD HEALTHCARE & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTLEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-282-3268
Mailing Address - Street 1:3050 ROYAL BLVD S
Mailing Address - Street 2:STE. 190
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4427
Mailing Address - Country:US
Mailing Address - Phone:470-282-3268
Mailing Address - Fax:470-268-7957
Practice Address - Street 1:600 BACON ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TX
Practice Address - Zip Code:77864-2575
Practice Address - Country:US
Practice Address - Phone:936-348-9097
Practice Address - Fax:936-348-9212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5342Medicaid
TX5342Medicaid