Provider Demographics
NPI:1750381737
Name:DADE HEALTH & REHAB, LLC
Entity type:Organization
Organization Name:DADE HEALTH & REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:706-378-0940
Mailing Address - Street 1:1234 HIGHWAY 301
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-4727
Mailing Address - Country:US
Mailing Address - Phone:706-657-4171
Mailing Address - Fax:706-657-6799
Practice Address - Street 1:1234 HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752-4727
Practice Address - Country:US
Practice Address - Phone:706-657-4171
Practice Address - Fax:706-657-6799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-041-1809314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00142865AMedicaid
GA00142865AMedicaid