Basic Information
| Provider Information | |||||||||
| NPI: | 1609809896 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PALMYRA NURSING HOME, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 385 | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317020385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2296390021 | ||||||||
| FaxNumber: | 2296390081 | ||||||||
| Practice Location | |||||||||
| Address1: | 1904 PALMYRA RD | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317011575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2298830500 | ||||||||
| FaxNumber: | 2298833590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KING | ||||||||
| AuthorizedOfficialFirstName: | DAVIS | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2296390021 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1047703 | GA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.