Provider Demographics
NPI:1841238326
Name:DAWSON MANOR NURSING HOME LLC
Entity Type:Organization
Organization Name:DAWSON MANOR NURSING HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHALONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:478-995-5016
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:GA
Mailing Address - Zip Code:39842-0607
Mailing Address - Country:US
Mailing Address - Phone:229-995-5016
Mailing Address - Fax:229-995-3272
Practice Address - Street 1:1159 GEORGIA AVE SE
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:GA
Practice Address - Zip Code:39842
Practice Address - Country:US
Practice Address - Phone:229-995-5016
Practice Address - Fax:229-995-3272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-135-1716314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00140808AMedicaid
51001669 001OtherBCBS
GA00140808AMedicaid