Provider Demographics
| NPI: | 1003943747 | 
|---|---|
| Name: | LILLIAN G. CARTER NURSING CENTER LLC | 
| Entity type: | Organization | 
| Organization Name: | LILLIAN G. CARTER NURSING CENTER LLC | 
| Other - Org Name: | <UNAVAIL> | 
| Other - Org Type: | |
| Authorized Official - Title/Position: | VP OF FINANCIAL REPORTING | 
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | KIM | 
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | SHEFFIELD | 
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 478-621-2100 | 
| Mailing Address - Street 1: | 225 HOSPITAL ST | 
| Mailing Address - Street 2: | |
| Mailing Address - City: | PLAINS | 
| Mailing Address - State: | GA | 
| Mailing Address - Zip Code: | 31780-5544 | 
| Mailing Address - Country: | US | 
| Mailing Address - Phone: | 229-824-7796 | 
| Mailing Address - Fax: | 229-824-7800 | 
| Practice Address - Street 1: | 225 HOSPITAL ST | 
| Practice Address - Street 2: | |
| Practice Address - City: | PLAINS | 
| Practice Address - State: | GA | 
| Practice Address - Zip Code: | 31780-5544 | 
| Practice Address - Country: | US | 
| Practice Address - Phone: | 229-824-7796 | 
| Practice Address - Fax: | 229-824-7800 | 
| EIN: | <UNAVAIL> | 
| Is Organization Subpart?: | No | 
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-02-28 | 
| Last Update Date: | 2020-08-22 | 
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: | 
Provider Licenses
| State | License ID | Taxonomies | 
|---|---|---|
| GA | 1-129-1714 | 385H00000X | 
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | 
|---|---|---|---|---|
| Yes | 385H00000X | Respite Care Facility | Respite Care |