Organization
COFFEE COUNTY NURSING HOME LLC
Active
Other names
Vista Park Health and Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
TARA BRIGMOND (ADMINISTRATOR)
(912) 384-7811
Entity
Organization
Contact information
Practice address
1310 GORDON ST W, DOUGLAS, GA 31533-3432
(912) 384-7811
(912) 384-7695
Mailing address
1310 GORDON ST W, DOUGLAS, GA 31533-3432
(912) 384-7811
(912) 384-7695
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1-034-1728
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000142931A
—
GA
01
—
51526538 001
BCBS
—
Enumeration date
07/01/2006
Last updated
02/17/2026
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