Provider Demographics
NPI:1457375099
Name:AUGUSTA FACILITY OPERATIONS, LLC
Entity Type:Organization
Organization Name:AUGUSTA FACILITY OPERATIONS, LLC
Other - Org Name:AUGUSTA NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:USSERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-571-1550
Mailing Address - Street 1:83 CROSS ROAD LN
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2331
Mailing Address - Country:US
Mailing Address - Phone:540-885-8424
Mailing Address - Fax:
Practice Address - Street 1:83 CROSS ROAD LN
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2331
Practice Address - Country:US
Practice Address - Phone:540-885-8424
Practice Address - Fax:540-885-8434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1457375099Medicaid
5880490001Medicare ID - Type UnspecifiedDMEPOS PTAN LEGACY NO.
49-5336Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER