Provider Demographics
NPI:1669509865
Name:BULLOCH COUNTY LTC, LLC
Entity Type:Organization
Organization Name:BULLOCH COUNTY LTC, LLC
Other - Org Name:EAGLE HEALTH & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCIAL REPORTING
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-621-2100
Mailing Address - Street 1:PO BOX 746
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-0746
Mailing Address - Country:US
Mailing Address - Phone:912-764-4575
Mailing Address - Fax:912-764-3916
Practice Address - Street 1:405 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5409
Practice Address - Country:US
Practice Address - Phone:912-764-4575
Practice Address - Fax:912-764-3916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-016-1802385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care