Provider Demographics
NPI:1689631103
Name:CANDLER COUNTY II LTC LLC
Entity Type:Organization
Organization Name:CANDLER COUNTY II LTC LLC
Other - Org Name:ORCHARD HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEABURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-685-5072
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:GA
Mailing Address - Zip Code:30451-0118
Mailing Address - Country:US
Mailing Address - Phone:912-685-5072
Mailing Address - Fax:912-685-4024
Practice Address - Street 1:1321 PULASKI SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:GA
Practice Address - Zip Code:30451-0118
Practice Address - Country:US
Practice Address - Phone:912-685-5072
Practice Address - Fax:912-685-4024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-021-1899314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00142656AMedicaid
115522Medicare Oscar/Certification