Provider Demographics
NPI:1750478947
Name:THI OF GEORGIA AT SHAMROCK, LLC
Entity Type:Organization
Organization Name:THI OF GEORGIA AT SHAMROCK, LLC
Other - Org Name:SHAMROCK NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-272-1133
Mailing Address - Street 1:930 RIDGEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9390
Mailing Address - Country:US
Mailing Address - Phone:410-773-1000
Mailing Address - Fax:
Practice Address - Street 1:1634 TELFAIR ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3115
Practice Address - Country:US
Practice Address - Phone:478-272-1133
Practice Address - Fax:478-275-0548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00141281AMedicaid
115495Medicare Oscar/Certification