Brentwood Nursing LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1-111-1746 Issued in GA

Legal business name

BRENTWOOD NURSING LLC

Doing business as

Fort Valley Health Care

Practice address

604 Bluebird Blvd
Fort Valley, GA 31030-5081

Phone

(478) 825-2031

Fax

(478) 825-2041

NPI assigned

Dec 13, 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

• Fort Valley Health Care Doing business as

Tax ID family

Brentwood Nursing LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Fort Valley Operator LLC

  dba Fort Valley Health and Rehab

  • Skilled Nursing Facility
  • Fort Valley, GA
  • NPI 1093987232
  NPD tax ID

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222646400000",
    "number": "1376604082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 BLUEBIRD BLVD",
            "city": "FORT VALLEY",
            "state": "GA",
            "postal_code": "310305081",
            "telephone_number": "478-825-2031",
            "fax_number": "478-825-2041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 BLUEBIRD BLVD",
            "city": "FORT VALLEY",
            "state": "GA",
            "postal_code": "310305081",
            "telephone_number": "478-825-2031",
            "fax_number": "478-825-2041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENTWOOD NURSING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "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": "1-111-1746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00141028A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Valley Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bio-Medical Applications of Georgia, Inc. (FMC Fort Valley Dialysis)
• Rose C Birmingham
• Danielle Bivens
• Kenneth M Bleicher
• Jennifer Bowens, CERTIFIED HAIR LOSS
• Amy Diane Brigman, FNP-C
• Brown Family Practice, LLC
• Crystal Lynn Brown, M.D.
• O'Mariana Brown
• Tammi L Cantrell

• Skilled Nursing Facility in Fort Valley, GA
• Providers in Fort Valley, 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.