Provider Demographics
NPI:1053724864
Name:MACON REHABILITATION AND HEALTHCARE CENTER, LLC
Entity type:Organization
Organization Name:MACON REHABILITATION AND HEALTHCARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-626-0000
Mailing Address - Street 1:505 COLISEUM DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3840
Mailing Address - Country:US
Mailing Address - Phone:478-743-8687
Mailing Address - Fax:478-744-0699
Practice Address - Street 1:505 COLISEUM DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3840
Practice Address - Country:US
Practice Address - Phone:478-743-8687
Practice Address - Fax:478-744-0699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW ARK OPERATOR HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-09
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000141523AMedicaid
GA115362Medicare Oscar/Certification