BULLOCH COUNTY LTC, LLC (NPI# 1669509865) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669509865 |
| 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 | 2007-02-27 |
| 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 | 385H00000X | Respite Care | 1-016-1802 | GA | Respite Care Facility |
| Other Name | Type Code |
|---|---|
| Eagle Health & Rehabilitation | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548397300 | Bulloch County Ltc, LLC | Clinic/Center | 405 S College St, Statesboro, GA 30458-5409 | 2007-02-28 |
| 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 |
| 1548397300 | Bulloch County Ltc, LLC | Clinic/Center | 405 S College St, Statesboro, GA 30458-5409 | 2007-02-28 |
| 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 | 385H00000X |
| Grouping | Respite Care Facility |
| Classification | Respite Care |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124628144 | Nurturing Love Inc | Respite Care | 704 Holly Dr, Valdosta, GA 31602-3306 | 2020-10-28 |
| 1548877350 | Rahco Athens, LLC | Respite Care | 1711 Meriweather Dr Ste 100, Watkinsville, GA 30677-7789 | 2020-09-25 |
| 1689223588 | Carebrand Health Care LLC | Respite Care | 106 Loblolly Ln, Albany, GA 31721-7724 | 2019-09-04 |
| 1861959793 | A Partner In Care Home Care | Respite Care | 2330 Scenic Hwy S Ste 317, Snellville, GA 30078-3115 | 2019-02-27 |
| 1285162529 | Jwh Service Partners, Inc | Respite Care | 4480 Valnorth Dr Ste D, Valdosta, GA 31602-6818 | 2017-05-31 |
| 1083159156 | Unique Individual Inc. | Respite Care | 4100 Cascade Rd Sw, Atlanta, GA 30331-7244 | 2016-12-28 |
| 1326599887 | Corey Young | Respite Care | 1270 Caroline St Ne Ste D120, 225, Atlanta, GA 30307-2758 | 2016-10-20 |
| 1548717408 | Sask Home Care | Respite Care | 6728 Highway 85, Suite C3, Riverdale, GA 30274-2317 | 2016-09-07 |
| 1821455759 | Home Away From Home | Respite Care | 5031 Glore Rd Sw, Mableton, GA 30126-5509 | 2016-01-22 |
| 1831575349 | In My Childrens Name Inc | Respite Care | 318 South Ave Se, Marietta, GA 30060-2384 | 2015-08-06 |
| Find all providers with the same taxonomy | ||||
| City | STATESBORO |
| Zip Code | 30458 |
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| 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.