Provider Demographics
NPI:1710143185
Name:ALTAMAHA NURSING LLC
Entity Type:Organization
Organization Name:ALTAMAHA NURSING LLC
Other - Org Name:ALTAMAHA HEALTHCARE CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-644-0471
Mailing Address - Street 1:1311 W CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-0614
Mailing Address - Country:US
Mailing Address - Phone:912-427-7792
Mailing Address - Fax:912-530-9425
Practice Address - Street 1:1311 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0614
Practice Address - Country:US
Practice Address - Phone:912-427-7792
Practice Address - Fax:912-530-9425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11511941314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00140027AMedicaid
115577Medicare Oscar/Certification