Organization
NDE, LLC
Active
Other names
Life Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY TOLSON (MANAGER)
(404) 644-0471
Entity
Organization
Contact information
Practice address
176 LINCOLN AVE, FITZGERALD, GA 31750-8447
(229) 423-5621
(229) 423-8723
Mailing address
176 LINCOLN AVE, FITZGERALD, GA 31750-8447
(229) 423-5621
(229) 423-8723
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
10091938
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00140665A
—
GA
Enumeration date
08/04/2008
Last updated
08/04/2008
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