Sunbridge Jeff Davis Healthcare LLC
Organization Active NPI Skilled Nursing Facility · Hazlehurst, GA
NPI 1891746889 · NPPES record last updated Jan 6, 2010
Key facts
- NPI
- 1891746889
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 10801485 (GA)
- Legal business name
- SUNBRIDGE JEFF DAVIS HEALTHCARE LLC
- Practice address
- 180 Burketts Ferry Rd
Hazlehurst, GA 31539-7132 - Phone
- (912) 375-3677
- Fax
- (912) 375-9974
- NPI assigned
- May 13, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- SUNBRIDGE HEALTHCARE CORPORATION
Authorized official
- Name
- William A. Mathies
- Title
- President Director
- Phone
- (505) 821-3355
Member of 2
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D0928733 | Hazelhurst Court Care and Rehabilitation Center | Certificate of waiver | May 26, 2027 |
National Provider Directory
- Part of
- Terrace Hghts Nursing H
Locations
180 Burketts Ferry Rd
Hazlehurst, GA 31539
Phone (912) 375-3677
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 10801485 | GA | Yes |
Addresses
Primary practice location
180 Burketts Ferry Rd
Hazlehurst, GA 31539-7132
Mailing address
101 Sun Ave NE
Compliance Department
Albuquerque, NM 87109-4373
Phone (505) 468-5604
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00059705A | Medicaid | GA |
Other names
- Hazelhurst Court Care and Rehabilitation Center
Other providers in Hazlehurst, GA
- Sidney P Johnson, M.D. P.C
- Southeast Georgia Homehealth Care Inc.
- Southern Eyecare, P.C.
- Dana Vanessa Stone
- Ethan Stone
- Sunrise Behavioral Therapy LLC
- T&R Carepack Solutions LLC
- Cara Taylor
- The Medicine of Hazlehurst LLC
- Tony Sparks, LLC Dba Hazlehurst Pediatrics
All providers in Hazlehurst, GA · Skilled Nursing Facility in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 6, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.