Provider Demographics
NPI:1982090486
Name:ROOSEVELT WARM SPRINGS REHABILITATION & SPECIALTY HOSPITALS
Entity Type:Organization
Organization Name:ROOSEVELT WARM SPRINGS REHABILITATION & SPECIALTY HOSPITALS
Other - Org Name:ROOSEVELT WARM SPRINGS HOSPITALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILDER
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:706-655-5461
Mailing Address - Street 1:6135 ROOSEVELT HWY
Mailing Address - Street 2:POB 280
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:706-655-5457
Practice Address - Street 1:6135 ROOSEVELT HIGHWAY
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:31830-0280
Practice Address - Country:US
Practice Address - Phone:706-655-5461
Practice Address - Fax:706-655-5457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA099-684282E00000X
GA099-685283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
No282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000000778AMedicaid
GA113028Medicare PIN
GA112000Medicare Oscar/Certification