Covington Manor Nursing Home LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

106867 Issued in GA

Legal business name

COVINGTON MANOR NURSING HOME LLC

Doing business as

Covington Manor Nursing Home

Practice address

4148 Carroll St SW
Covington, GA 30014-2706

Phone

(478) 783-4988

NPI assigned

Oct 14, 2005

Organization subpart

No

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

Authorized official

Name

Deborah Coley

Title

Medicare Part B Coordinator

Phone

(478) 783-4988

Specialties & licenses 1

Addresses

Other names 1

• Covington Manor Nursing Home Doing business as

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1598754343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 INDUSTRIAL BLVD",
            "address_2": "P.O. BOX 1033",
            "city": "HAWKINSVILLE",
            "state": "GA",
            "postal_code": "310362106",
            "telephone_number": "478-783-4988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4148 CARROLL ST SW",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300142706",
            "telephone_number": "478-783-4988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVINGTON MANOR NURSING HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COLEY",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "MEDICARE PART B COORDINATOR",
        "authorized_official_telephone_number": "478-783-4988"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "106867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Covington Manor Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Covington, GA
• Providers in Covington, GA by specialty
• Durable Medical Equipment & Medical Supplies in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.