Organization
BRENTWOOD NURSING LLC
Active
Other names
Fort Valley Health Care
Organization subpart
No
Provider details
NPI number
Authorized official
TYGH BROGDON (MANAGER)
(770) 650-8773
Entity
Organization
Contact information
Practice address
604 BLUEBIRD BLVD, FORT VALLEY, GA 31030-5081
(478) 825-2031
(478) 825-2041
Mailing address
604 BLUEBIRD BLVD, FORT VALLEY, GA 31030-5081
(478) 825-2031
(478) 825-2041
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1-111-1746
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00141028A
—
GA
Enumeration date
12/13/2006
Last updated
09/29/2008
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