Provider Demographics
NPI:1174514160
Name:KEYSVILLE NURSING HOME & REHABILITATION CENTER
Entity type:Organization
Organization Name:KEYSVILLE NURSING HOME & REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:N
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-547-2591
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:KEYSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30816-0220
Mailing Address - Country:US
Mailing Address - Phone:706-547-2591
Mailing Address - Fax:706-547-0492
Practice Address - Street 1:1005 HIGHWAY 88 NORTH
Practice Address - Street 2:
Practice Address - City:KEYSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30816
Practice Address - Country:US
Practice Address - Phone:706-547-2591
Practice Address - Fax:706-547-0492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-017-1616314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00141655AMedicaid
GA00141655AMedicaid