Nde, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

10091938 Issued in GA

Legal business name

NDE, LLC

Doing business as

Life Care Center

Practice address

176 Lincoln Ave
Fitzgerald, GA 31750-8447

Phone

(229) 423-5621

Fax

(229) 423-8723

NPI assigned

Aug 4, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Terry Tolson

Title

Manager

Phone

(404) 644-0471

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Life Care Center Doing business as

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

{
    "created_epoch": "1217808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217808000000",
    "number": "1811153356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "176 LINCOLN AVE",
            "city": "FITZGERALD",
            "state": "GA",
            "postal_code": "317508447",
            "telephone_number": "229-423-5621",
            "fax_number": "229-423-8723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "176 LINCOLN AVE",
            "city": "FITZGERALD",
            "state": "GA",
            "postal_code": "317508447",
            "telephone_number": "229-423-5621",
            "fax_number": "229-423-8723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NDE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-04",
        "last_updated": "2008-08-04",
        "status": "A",
        "authorized_official_last_name": "TOLSON",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "404-644-0471",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "10091938",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00140665A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Fitzgerald, GA
• Providers in Fitzgerald, 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 Aug 4, 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.