Provider Demographics
NPI:1972518611
Name:MONROE NURSING HOME INC
Entity Type:Organization
Organization Name:MONROE NURSING HOME INC
Other - Org Name:PARK PLACE NURSING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:E
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:770-267-8677
Mailing Address - Street 1:1865 BOLD SPRINGS RD NW
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30656-4605
Mailing Address - Country:US
Mailing Address - Phone:770-267-8677
Mailing Address - Fax:770-267-7831
Practice Address - Street 1:1865 BOLD SPRINGS RD NW
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30656-4605
Practice Address - Country:US
Practice Address - Phone:770-267-8677
Practice Address - Fax:770-267-7831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11471218314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00002164AMedicaid
115005Medicare PIN