Provider Demographics
NPI:1952781759
Name:ROOSEVELT WARM SPRINGS REHABILITATION & SPECIALTY HOSPITALS, INC
Entity Type:Organization
Organization Name:ROOSEVELT WARM SPRINGS REHABILITATION & SPECIALTY HOSPITALS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-721-5505
Mailing Address - Street 1:6135 ROOSEVELT HWY
Mailing Address - Street 2:
Mailing Address - City:WARM SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:31830-2757
Mailing Address - Country:US
Mailing Address - Phone:706-655-5461
Mailing Address - Fax:706-644-5457
Practice Address - Street 1:6135 ROOSEVELT HWY
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:31830-2757
Practice Address - Country:US
Practice Address - Phone:706-655-5461
Practice Address - Fax:706-644-5457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059603207Q00000X
GA061328207Q00000X
GA034164207Q00000X
GA045791207R00000X
GA036164207R00000X
GA073402207R00000X
GA047852207R00000X
037166207R00000X
GA070267208100000X
GA048738208100000X
GA026588208100000X
GA009537208100000X
GA013142208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I087470OtherMEDICARE NUMBER
GA202I252544OtherMEDICARE NUMBER
GA202I501877OtherMEDICARE NUMBER
GA202I086305OtherMEDICARE NUMBER
GA2021726235OtherMEDICARE NUMBER
GA511I5200126OtherMEDICARE NUMBER
GA202I118135OtherMEDICARE NUMBER
GA202I56862OtherMEDICARE NUMBER
GA202I55969OtherMEDICARE NUMBER