Provider Demographics
NPI:1659619450
Name:GOODWILL HEALTHCARE & REHAB LLC
Entity Type:Organization
Organization Name:GOODWILL HEALTHCARE & REHAB LLC
Other - Org Name:GOODWILL HEALTH & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-648-6750
Mailing Address - Street 1:4373 HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-2759
Mailing Address - Country:US
Mailing Address - Phone:478-784-1500
Mailing Address - Fax:478-784-7638
Practice Address - Street 1:4373 HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-2759
Practice Address - Country:US
Practice Address - Phone:478-784-1500
Practice Address - Fax:478-784-7638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000141193AMedicaid
115486Medicare Oscar/Certification