NPIMap

Organization Active NPI

Bulloch County LTC LLC

  • Skilled Nursing Facility
  • Statesboro, GA
National Provider Identifier
1023044518
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
1-016-1898 Issued in GA
Legal business name
BULLOCH COUNTY LTC LLC
Practice address
405 S College St
Statesboro, GA 30458-5409
Phone
(912) 764-4575
Fax
(912) 764-3916
NPI assigned
Jun 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Taylor McCoy
Title
Administrator
Phone
(912) 764-4575

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 1-016-1898 GA Primary

Addresses

Primary practice location

405 S College St
Statesboro, GA 30458-5409

Mailing address

PO Box 746
Statesboro, GA 30459-0746
Phone (912) 764-4575

Other identifiers 1

IdentifierTypeStateIssuer
000143151AMedicaidGA

Other names 1

  • Eagle Health and Rehabilitation Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070409000136 GA Part A Provider - Skilled Nursing Facility 5890899405 Practice locations: Statesboro, GA

Skilled nursing facility certification: CCN 115618

Legal name
BULLOCH COUNTY LTC LLC
Doing business as
EAGLE HEALTH AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 1, 1996
Last certification
Apr 25, 2025
Beds
99
Ownership / control type
Other Nonprofit
Multi-facility organization
Piedmont Regional Health
Most recent change of ownership
Nov 1, 2006
Organization structure
LLCNon-profit
Enrollment address
405 S College St
Box 746
Statesboro, GA 30458-5409
Nursing home name
EAGLE HEALTH & REHABILITATION
Affiliated entity
ETHICA HEALTH

Care Compare: Nursing home

Medicare Care Compare
Listed as
Eagle Health & RehabilitationCCN 115618
Overall star rating
3 of 5
Health inspections
4 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Other
Certified
Sep 1, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9953.3 residents per day on average
Chain
Ethica Health50 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Bulloch County LTC LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

405 S College St
#746
Statesboro, GA 30458
Phone (912) 764-4575

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Paul a Cable Individual Managing Control - Governing BodyBoard Member Mar 14, 2003
Ralph Parks Warnock Individual Managing Control - Governing BodyBoard Member Jun 23, 2020
Ronnie D Rollins Individual Managing Control - Governing BodyBoard Member Mar 14, 2003
Taylor McCoy Individual Operational/Managerial Control Apr 21, 2025
Adp of the SNF Jul 15, 2025
Tiffany Peavy Individual Operational/Managerial Control Jan 1, 2026
Managing Control - Governing BodyVice President of Operations Jan 1, 2026
Organization, Macon, GA LLC, Non-profit Adp of the SNF Jul 14, 2025
Maulikkumar a Patel Individual Operational/Managerial Control Aug 1, 2023
Adp of the SNF Mar 1, 2025
Kathryn Dennis Individual Managing Control - Governing BodyDivision Vice President Nov 17, 2015
Organization, Hawkinsville, GA Corporation, Medical provider/supplier, Non-profit Adp of the SNF Jul 14, 2025
Clinical Services Inc Organization, Gray, GA Corporation, Management services company, Non-profit, Chain home office Operational/Managerial Control Nov 1, 2006
Adp of the SNF Jul 14, 2025
Community Health Systems Inc Organization, Macon, GA Corporation, Non-profit Indirect Ownership Interest Nov 1, 2006 100%
Organization, Gray, GA LLC, Medical provider/supplier, Non-profit Adp of the SNF Jul 14, 2025
Health Scholarships Inc Organization, Gray, GA Corporation, Holding company, Non-profit Direct Ownership Interest Nov 1, 2025 100%
Individual Adp of the SNF Jan 1, 2025
Organization, Gray, GA LLC, For-profit Adp of the SNF Jun 22, 1998
Pamela Eason Individual Operational/Managerial Control Jul 10, 2023
Joseph a Wall Individual Managing Control - Governing BodyBoard Member Mar 14, 2003
Joseph Nichols Individual Managing Control - Governing BodyBoard Member Nov 19, 2024

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 49

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 49

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1023044518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304590746",
            "telephone_number": "912-764-4575",
            "fax_number": "912-764-3916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 S COLLEGE ST",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585409",
            "telephone_number": "912-764-4575",
            "fax_number": "912-764-3916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BULLOCH COUNTY LTC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "MCCOY",
        "authorized_official_first_name": "TAYLOR",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "912-764-4575"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "1-016-1898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000143151A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagle Health and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eagle Health and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Statesboro, GA

Sources for this page

Verify at the official NPI Registry.