Provider Demographics
NPI:1669625786
Name:HOG HOLDINGS LLC
Entity Type:Organization
Organization Name:HOG HOLDINGS LLC
Other - Org Name:HEART OF GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHISGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-888-3310
Mailing Address - Street 1:815 LEGION DR
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-6782
Mailing Address - Country:US
Mailing Address - Phone:478-374-5571
Mailing Address - Fax:
Practice Address - Street 1:815 LEGION DR
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6782
Practice Address - Country:US
Practice Address - Phone:478-374-5571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00141358AMedicaid
11-5471OtherMEDICARE PROVIDER NUMBER