Brentwood Nursing LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1-039-1747 Issued in GA

Legal business name

BRENTWOOD NURSING LLC

Doing business as

Roberta Health Care Center

Practice address

280 Myrtle Drive
Roberta, GA 31078

Phone

(478) 836-3101

Fax

(478) 836-2700

NPI assigned

Dec 14, 2006

Last updated

Sep 29, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tygh Brogdon

Title

Manager

Phone

(770) 650-8773

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Roberta Health Care Center Doing business as

Locations

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222646400000",
    "number": "1083776520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 MYRTLE DRIVE",
            "city": "ROBERTA",
            "state": "GA",
            "postal_code": "31078",
            "telephone_number": "478-836-3101",
            "fax_number": "478-836-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 MYRTLE DRIVE",
            "city": "ROBERTA",
            "state": "GA",
            "postal_code": "31078",
            "telephone_number": "478-836-3101",
            "fax_number": "478-836-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENTWOOD NURSING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2008-09-29",
        "status": "A",
        "authorized_official_last_name": "BROGDON",
        "authorized_official_first_name": "TYGH",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "770-650-8773"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "1-039-1747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00142777A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roberta Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Teresa Vanessa Aranda
• Alicia Ray Bryant, NP
• Careconnect Health, Inc. (CareConnect Family Practice)
• Jeremy Antoine Colbert, RN
• Crawford County Board of Education
• Crawford County Health Department

• Skilled Nursing Facility in Roberta, GA
• Providers in Roberta, GA by specialty
• Skilled Nursing Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.