Provider Demographics
NPI:1982180428
Name:HEARDMONT HEALTH PROPERTIES LLC
Entity Type:Organization
Organization Name:HEARDMONT HEALTH PROPERTIES LLC
Other - Org Name:HEARDMONT HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WINGET
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:478-974-0006
Mailing Address - Street 1:1043 LONGSTREET RD
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-5185
Mailing Address - Country:US
Mailing Address - Phone:706-283-5439
Mailing Address - Fax:706-213-9301
Practice Address - Street 1:1043 LONGSTREET RD
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-5185
Practice Address - Country:US
Practice Address - Phone:706-283-5439
Practice Address - Fax:706-213-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility