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 |