Provider Demographics
NPI:1821482696
Name:MEADOWS PARK HEALTH & REHABILITATION LLC
Entity Type:Organization
Organization Name:MEADOWS PARK HEALTH & REHABILITATION LLC
Other - Org Name:MEADOWS PARK HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-403-3400
Mailing Address - Street 1:119 MEADOWS PKWY W
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-5666
Mailing Address - Country:US
Mailing Address - Phone:912-403-3400
Mailing Address - Fax:
Practice Address - Street 1:119 MEADOWS PKWY W
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-5666
Practice Address - Country:US
Practice Address - Phone:912-403-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003167911AMedicaid
GA003167911AMedicaid