Provider Demographics
NPI:1760892657
Name:ROOSEVELT WARM SPRINGS REHABILITATION & SPECIALTY HOSPITALS, INC.
Entity Type:Organization
Organization Name:ROOSEVELT WARM SPRINGS REHABILITATION & SPECIALTY HOSPITALS, INC.
Other - Org Name:ROOSEVELT WARM SPRINGS REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR & COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MORK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-655-5515
Mailing Address - Street 1:6135 ROOSEVELT HWY
Mailing Address - Street 2:PO BOX 280
Mailing Address - City:WARM SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:31830-2757
Mailing Address - Country:US
Mailing Address - Phone:706-655-5461
Mailing Address - Fax:706-655-5011
Practice Address - Street 1:6135 ROOSEVELT HWY
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:31830-2757
Practice Address - Country:US
Practice Address - Phone:706-655-5461
Practice Address - Fax:706-655-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA099684283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000000778AMedicaid
GA000000778AMedicaid