# COFFEE COUNTY NURSING HOME, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Shady Acres
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912036989
- **Authorized official:** KIM SHEFFIELD (VP OF FINANCIAL REPORTING)
- **Authorized official phone:** (478) 621-2100

## Contact information

- **Practice address:** 1310 GORDON ST W, DOUGLAS, GA 31533-3432
- **Practice address phone:** (912) 384-7811
- **Practice address fax:** (912) 384-7695
- **Mailing address:** 1310 GORDON ST W, DOUGLAS, GA 31533-3432
- **Mailing address phone:** (912) 384-7811
- **Mailing address fax:** (912) 384-7695

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 385H00000X | Respite Care | 1-056-1784 | GA | Yes |

## Other

- **Enumeration date:** 03/05/2007
- **Last updated:** 08/22/2020