COFFEE COUNTY NURSING HOME, LLC (NPI# 1730218702) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730218702 |
| Entity Type | Organization |
| Organization Name | COFFEE COUNTY NURSING HOME, LLC |
| Other Organization Name | SHADY ACRES |
| Practice Address |
1310 Gordon St W Douglas GA 31533-3432 |
| Practice Telephone | 9123847811 |
| Practice Fax Number | 9123847695 |
| Mailing Telephone | 9123847811 |
| Mailing Fax Number | 9123847695 |
| Enumeration Date | 2007-03-05 |
| 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 |
1-056-1784 | GA | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Shady Acres | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912036989 | Coffee County Nursing Home, LLC | Respite Care | 1310 Gordon St W, Douglas, GA 31533-3432 | 2007-03-05 |
| Street Address |
1310 GORDON ST W |
| City | DOUGLAS |
| State | GA |
| Zip Code | 31533-3432 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881623098 | Coffee County Nursing Home LLC | Skilled Nursing Facility | 1310 Gordon St W, Douglas, GA 31533-3432 | 2006-07-01 |
| 1912036989 | Coffee County Nursing Home, LLC | Respite Care | 1310 Gordon St W, Douglas, GA 31533-3432 | 2007-03-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508470964 | Swain Drug Company LLC | Pharmacy | 855 Bowens Mill Rd Sw Suite E, Douglas, GA 31533 | 2020-09-03 |
| 1811528649 | Unison Behavioral Health | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 211 North Street, Douglas, GA 31533 | 2020-01-30 |
| 1952940793 | Teresa Smith | Pharmacist | 901 W Ward St, Douglas, GA 31533 | 2019-12-26 |
| 1447641048 | Jennifer Spivey | Nurse Practitioner | 326 Shirley Avenue, Douglas, GA 31533 | 2015-02-18 |
| 1972914497 | Jessica Lynne Courson | Nurse Practitioner | 903 West Ward Street, Suite B, Douglas, GA 31533 | 2014-05-19 |
| 1063840296 | South Central Primary Care Center | Clinic/Center | 303 Shirley Ave, Ste B, Douglas, GA 31533 | 2013-10-25 |
| 1336411008 | Unison Behavioral Health | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 118 Coweta Avenue South, Douglas, GA 31533 | 2012-01-27 |
| 1346482700 | V and V Clinic | Pediatrics | 1020 West Bryan Street, Douglas, GA 31533 | 2009-04-01 |
| 1063650406 | Jayla Snipes Bullock | Speech-Language Pathologist | 618 Bowens Mill Road Sw, Douglas, GA 31533 | 2009-01-22 |
| 1417112707 | Southern Community Services Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 315 S. Gaskin Ave, Douglas, GA 31533 | 2008-07-25 |
| Find all providers in zip 31533 | ||||
| Taxonomy Code | 261QA0600X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Day Care |
| Definition to come... |
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|---|---|---|---|---|
| 1609481506 | Loving Hands Foundation Incorporated | Clinic/Center | 206 Union St, Lagrange, GA 30241-3343 | 2020-09-09 |
| 1356962443 | Southern Hospitality Adult Day Health Agency LLC | Clinic/Center | 3349 Northside Dr W, Statesboro, GA 30458-2178 | 2020-04-30 |
| 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 |
| Find all providers with the same taxonomy | ||||
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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.