Provider Demographics
NPI:1184613358
Name:NEWNAN NURSING AND REHABILITATION LLC
Entity type:Organization
Organization Name:NEWNAN NURSING AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-400-8850
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30264-0040
Mailing Address - Country:US
Mailing Address - Phone:770-253-7160
Mailing Address - Fax:770-253-8232
Practice Address - Street 1:244 E BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1818
Practice Address - Country:US
Practice Address - Phone:770-253-7160
Practice Address - Fax:770-253-8232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-038-235314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00040719Medicaid
GA115138Medicare ID - Type Unspecified