Organization
HOG HOLDINGS LLC
Active
Other names
Heart of Georgia
Organization subpart
No
Provider details
NPI number
Authorized official
BARRY SHISGAL (MANAGER/DIRECTOR)
(786) 888-3310
Entity
Organization
Contact information
Practice address
815 LEGION DR, EASTMAN, GA 31023-6782
(478) 374-5571
Mailing address
815 LEGION DR, EASTMAN, GA 31023-6782
(478) 374-5571
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00141358A
—
GA
01
—
11-5471
MEDICARE PROVIDER NUMBER
—
Enumeration date
11/03/2008
Last updated
11/03/2008
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