Organization
BRENTWOOD NURSING LLC
Active
Other names
Roberta Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
TYGH BROGDON (MANAGER)
(770) 650-8773
Entity
Organization
Contact information
Practice address
280 MYRTLE DRIVE, ROBERTA, GA 31078
(478) 836-3101
(478) 836-2700
Mailing address
280 MYRTLE DRIVE, ROBERTA, GA 31078
(478) 836-3101
(478) 836-2700
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1-039-1747
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00142777A
—
GA
Enumeration date
12/14/2006
Last updated
09/29/2008
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