Provider Demographics
NPI:1912989344
Name:BLAIR HOUSE INC.
Entity Type:Organization
Organization Name:BLAIR HOUSE INC.
Other - Org Name:BLAIR HOUSE NURSING AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-738-2581
Mailing Address - Street 1:2541 MILLEDGEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4954
Mailing Address - Country:US
Mailing Address - Phone:706-738-2581
Mailing Address - Fax:706-738-5235
Practice Address - Street 1:2541 MILLEDGEVILLE RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4954
Practice Address - Country:US
Practice Address - Phone:706-738-2581
Practice Address - Fax:706-738-5235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-121-1724314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA115334Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER