COFFEE COUNTY NURSING HOME LLC (NPI# 1881623098) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881623098 |
| Entity Type | Organization |
| Organization Name | COFFEE COUNTY NURSING HOME LLC |
| Other Organization Name | VISTA PARK HEALTH AND REHABILITATION |
| 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 | 2006-07-01 |
| Last Update Date | 2020-10-08 |
| Authorized Official Name | STACEY HILL (ADMINISTRATOR) |
| Authorized Official Telephone | 9123847811 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 1-034-1728 | GA | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BCBS | 51526538 001 | 01 | |
| GA | 000142931A | 05 |
| Other Name | Type Code |
|---|---|
| Shady Acres Health and Rehabilitation | Doing Business As Name - Organization |
| Vista Park Health and Rehabilitation | Doing Business As Name - Organization |
| Street Address |
1310 GORDON ST W |
| City | DOUGLAS |
| State | GA |
| Zip Code | 31533-3432 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912036989 | Coffee County Nursing Home, LLC | Respite Care | 1310 Gordon St W, Douglas, GA 31533-3432 | 2007-03-05 |
| 1730218702 | Coffee County Nursing Home, LLC | Clinic/Center | 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 | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760652853 | Douglas Investments & Associates, LLC | Skilled Nursing Facility | 243 Wiley Rd, Douglas, MI 49406-5108 | 2008-03-05 |
| 1548206642 | Douglas Care Center, LLC | Skilled Nursing Facility | 1108 Birch, Douglas, WY 82633 | 2006-06-20 |
| 1588650543 | Nanmax Health Management Inc | Skilled Nursing Facility | 243 Wiley Road, Douglas, MI 49406-0217 | 2005-09-26 |
| 1255332383 | Kimberly Health Systems | Skilled Nursing Facility | 1108 Birch St, Douglas, WY 82633-2761 | 2005-08-10 |
| 1831195460 | Infinia At Douglas | Skilled Nursing Facility | 1400 N San Antonio Ave, Douglas, AZ 85607-2434 | 2005-06-28 |
| 1073850319 | Haven of Douglas, LLC | Skilled Nursing Facility | 1400 N San Antonio Ave, Douglas, AZ 85607-2434 | 2013-01-07 |
| 1366681520 | La Solana Care and Rehab, Inc | Skilled Nursing Facility | 1400 N San Antonio Ave, Douglas, AZ 85607-2434 | 2009-02-11 |
| 1306965165 | Douglas Care Center, LLC | Skilled Nursing Facility | 1108 Birch St, Douglas, WY 82633-2761 | 2007-03-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689281982 | Georgia Regional Health Services LLC | Skilled Nursing Facility | 3731 Lake Pass Ln, Suwanee, GA 30024-8422 | 2020-09-30 |
| 1124633268 | Lavender Mountain Senior Living Inc | Skilled Nursing Facility | 600 Eagle Lake Trl, Rome, GA 30165-2207 | 2020-09-15 |
| 1215550264 | Mesun Health Services, Inc | Skilled Nursing Facility | 88 Johnson Rd. Building #2, Lawrenceville, GA 30046 | 2020-05-26 |
| 1255966081 | Westminster Presbyterian Homes, Inc. | Skilled Nursing Facility | 1400 Live Oak Ln, Building 100, Athens, GA 30606 | 2020-03-12 |
| 1205486859 | Magnolia Manor of Liberty County, Inc. | Skilled Nursing Facility | 625 N Coastal Hwy # 17, Midway, GA 31320-3433 | 2019-09-16 |
| 1497301170 | Prestige Health Services LLC | Skilled Nursing Facility | 1770 Indian Trail Lilburn Rd Ste 420, Norcross, GA 30093-2644 | 2019-08-17 |
| 1043878721 | Keysville Ltc Management LLC | Skilled Nursing Facility | 1005 Ga Highway 88, Blythe, GA 30805-3911 | 2019-05-29 |
| 1689131724 | Favor Home Health Care Services, LLC | Skilled Nursing Facility | 51 Gallery Ct, Acworth, GA 30101-2709 | 2019-02-25 |
| 1104398866 | University Extended Care, Inc | Skilled Nursing Facility | 1005 Highway 88 N, Keysville, GA 30816 | 2018-12-19 |
| 1548745342 | Gacalhoun Snf LLC | Skilled Nursing Facility | 1387 Highway 41 N., Calhoun, GA 30701 | 2018-09-27 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on COFFEE COUNTY NURSING HOME 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.