Organization
FAYETTE COUNTY NURSING HOME LLC
Active
Other names
Southland Health and Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
SHANATHANIA MAHORN (ADMINISTRATOR)
(770) 631-9000
Entity
Organization
Contact information
Practice address
151 WISDOM RD, PEACHTREE CITY, GA 30269-3937
(770) 631-9000
(770) 487-2788
Mailing address
PO BOX 2747, PEACHTREE CITY, GA 30269-0747
(770) 631-9000
(770) 487-2788
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1-056-1784
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000409054A
—
GA
01
—
51043457 002
BCBS
—
Enumeration date
06/25/2006
Last updated
02/12/2026
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