BULLOCH COUNTY LTC, LLC (NPI# 1548397300) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548397300 |
| Entity Type | Organization |
| Organization Name | BULLOCH COUNTY LTC, LLC |
| Other Organization Name | EAGLE HEALTH & REHABILITATION |
| Practice Address |
405 S College St Statesboro GA 30458-5409 |
| Mailing Address |
Po Box 746 Statesboro GA 30459-0746 |
| Practice Telephone | 9127644575 |
| Practice Fax Number | 9127643916 |
| Mailing Telephone | 9127644575 |
| Mailing Fax Number | 9127643916 |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | KIM SHEFFIELD (VP OF FINANCIAL REPORTING) |
| Authorized Official Telephone | 4786212100 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA0600X |
Clinic/Center Specialization: Adult Day Care |
1-016-1802 | GA | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Eagle Health & Rehabilitation | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669509865 | Bulloch County Ltc, LLC | Respite Care | 405 S College St, Statesboro, GA 30458-5409 | 2007-02-27 |
| Street Address |
405 S COLLEGE ST |
| City | STATESBORO |
| State | GA |
| Zip Code | 30458-5409 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023044518 | Bulloch County Ltc LLC | Skilled Nursing Facility | 405 S College St, Statesboro, GA 30458-5409 | 2006-06-25 |
| 1134775182 | Southeast Lung & Critical Care Specialists P C | Internal Medicine | 405 S College St, Statesboro, GA 30458-5409 | 2019-08-15 |
| 1669509865 | Bulloch County Ltc, LLC | Respite Care | 405 S College St, Statesboro, GA 30458-5409 | 2007-02-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639642218 | Youtherapy | Counselor | 430 Northside Dr East, Suite 160 Mb326, Statesboro, GA 30458 | 2019-01-07 |
| 1053891853 | Alexandria Franklin | Specialist/Technologist | 1332 Southern Dr, Statesboro, GA 30458 | 2018-08-21 |
| 1740780006 | Michael Ryan Clark | Pharmacist | 556 Northside Drive, Statesboro, GA 30458 | 2018-02-13 |
| 1689186405 | Chandler James Herman | Specialist/Technologist | 590 Herty Dr., Statesboro, GA 30458 | 2017-11-02 |
| 1477009181 | Mama Doc Pediatrics, LLC | Pediatrics | 400 East Grady Street, Statesboro, GA 30458 | 2016-09-01 |
| 1053761171 | Rebekah Roessler | Specialist/Technologist | 2687 Akins Blvd, Statesboro, GA 30458 | 2016-06-20 |
| 1427412253 | Refocus Counseling and Consulting Services | Community/Behavioral Health | 4325 Country Club, 4, Statesboro, GA 30458 | 2016-04-07 |
| 1023408523 | Kacy H. Nesmith | Nurse Practitioner | 1098 Bermuda Run, Suite 6, Statesboro, GA 30458 | 2015-02-04 |
| 1760870398 | Jessica Pasternack | Specialist/Technologist | 2687 Akins Boulevard, Statesboro, GA 30458 | 2015-01-06 |
| 1922401629 | Nathan D'amico | Student in an Organized Health Care Education/Training Program | 15 W Grady Street Unit A, Statesboro, GA 30458 | 2014-10-08 |
| Find all providers in zip 30458 | ||||
| Taxonomy Code | 261QA0600X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Day Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356962443 | Southern Hospitality Adult Day Health Agency LLC | Clinic/Center | 3349 Northside Dr W, Statesboro, GA 30458-2178 | 2020-04-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609481506 | Loving Hands Foundation Incorporated | Clinic/Center | 206 Union St, Lagrange, GA 30241-3343 | 2020-09-09 |
| 1497383038 | Sheryl Dornblaser | Clinic/Center | 1180 Mckendree Church Rd Ste 107, Lawrenceville, GA 30043-5207 | 2020-03-30 |
| 1720616386 | Rainbow Senior Care Home Inc | Clinic/Center | 4405 International Blvd Ste B101, Norcross, GA 30093-3013 | 2020-03-30 |
| 1932733201 | Perfect Care, Inc | Clinic/Center | 114 Sullivan Dr, Americus, GA 31709-5534 | 2020-02-26 |
| 1710524483 | Norman Graham | Clinic/Center | 125 Marquis Dr, Fayetteville, GA 30214-1566 | 2019-12-02 |
| 1548802937 | Serenity Adult Day Health, Inc | Clinic/Center | 95 Truman Rd, Hawkinsville, GA 31036-4643 | 2019-10-17 |
| 1134778749 | Marietta Seniors Club LLC | Clinic/Center | 748 Lawrence St Ne, Marietta, GA 30060-2144 | 2019-09-06 |
| 1629626445 | Wholecare Wellness LLC | Clinic/Center | 5390 Peachtree Industrial Blvd Ste 130, Norcross, GA 30071-1566 | 2019-08-27 |
| 1750936498 | Sec of Georgia Corp | Clinic/Center | 5522 New Peachtree Rd Ste 128, Atlanta, GA 30341-2544 | 2019-08-08 |
| 1801354774 | Tracie Chislom | Clinic/Center | 1002 W Solomon St, Griffin, GA 30223-2632 | 2019-03-08 |
| Find all providers with the same taxonomy | ||||
| City | STATESBORO |
| Zip Code | 30458 |
Please comment or provide details below to improve the information on BULLOCH COUNTY LTC, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.