Provider Demographics
NPI:1659313716
Name:OCONEE HEALTH CARE LLC
Entity type:Organization
Organization Name:OCONEE HEALTH CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARNETRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-552-7381
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:OCONEE
Mailing Address - State:GA
Mailing Address - Zip Code:31067-0130
Mailing Address - Country:US
Mailing Address - Phone:478-552-7831
Mailing Address - Fax:478-552-4008
Practice Address - Street 1:107 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:OCONEE
Practice Address - State:GA
Practice Address - Zip Code:31067-0130
Practice Address - Country:US
Practice Address - Phone:478-552-7831
Practice Address - Fax:478-552-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-150-1702314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00142293AMedicaid
51552324 001OtherBCBS
115357Medicare Oscar/Certification