Organization
MEADOWBROOK NURSING HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS W PENLEY (CEO)
(706) 855-1773
Entity
Organization
Contact information
Practice address
4608 LAWRENCEVILLE HWY, TUCKER, GA 30084-2903
(770) 938-0118
(770) 491-8760
Mailing address
4608 LAWRENCEVILLE HWY, TUCKER, GA 30084-2903
(770) 938-0118
(770) 491-8760
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00141864A
—
GA
01
—
1054670001
DME#
—
Enumeration date
08/03/2005
Last updated
08/22/2020
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