Organization
PROVIDENCE HEALTH AND REHABILITATION CENTER, INC.
Active
Parent organization
PROHEALTH RESOURCE GROUP, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROHEALTH RESOURCE GROUP, INC.
Authorized official
MR. RICHARD E. FALLAW SR. (PRESIDENT)
(229) 268-7510
Entity
Organization
Contact information
Practice address
1011 S GREEN ST, THOMASTON, GA 30286-4643
(706) 647-6693
(706) 648-9255
Mailing address
1011 S GREEN ST, THOMASTON, GA 30286-4643
(706) 647-6693
(706) 648-9255
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1-145-1868
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00142612A
—
GA
01
—
51004538001
BLUE CROSS/BLUE SHIELD
—
Enumeration date
05/26/2006
Last updated
10/04/2007
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