Provider Demographics
NPI:1710035969
Name:HEALTHCARE OF BERRIEN COUNTY, INC.
Entity Type:Organization
Organization Name:HEALTHCARE OF BERRIEN COUNTY, INC.
Other - Org Name:BERRIEN NURSING CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEMARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-543-7309
Mailing Address - Street 1:405 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31639-2571
Mailing Address - Country:US
Mailing Address - Phone:229-543-7318
Mailing Address - Fax:229-543-1724
Practice Address - Street 1:405 LAUREL ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31639-2571
Practice Address - Country:US
Practice Address - Phone:229-543-7318
Practice Address - Fax:229-543-1724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10101119314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00143382AMedicaid
GA00143382AMedicaid