Provider Demographics
NPI:1871805010
Name:COBBLESTONE REHABILITATION AND HEALTHCARE CENTER, LLC
Entity type:Organization
Organization Name:COBBLESTONE 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 1:101 COBBLESTONE TRCE SE
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31788-7747
Mailing Address - Country:US
Mailing Address - Phone:229-985-3637
Mailing Address - Fax:229-985-3271
Practice Address - Street 1:101 COBBLESTONE TRCE SE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31788-7747
Practice Address - Country:US
Practice Address - Phone:229-985-3637
Practice Address - Fax:229-985-3271
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLIVE LEAF, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-03
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000142711AMedicaid
115667Medicare Oscar/Certification