Covington Manor Nursing Home, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

11071744 Issued in GA

Legal business name

COVINGTON MANOR NURSING HOME, LLC

Practice address

4148 Carroll St SW
Covington, GA 30014-2706

Phone

(770) 786-0427

Fax

(770) 385-9021

NPI assigned

Sep 26, 2006

Last updated

Aug 22, 2020By 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

Mr. Ronald Gary Crump

Title

President

Phone

(770) 786-0427

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Covington Manor Nursing Home 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.

• Pruitthealth - Covington LLC

  dba PruittHealth - Covington

  • Skilled Nursing Facility
  • Covington, GA
  • NPI 1457797177
  NPD tax ID

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1932200730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4148 CARROLL ST.",
            "address_2": "P.O. BOX 1369",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "30014",
            "telephone_number": "770-786-0427",
            "fax_number": "770-385-9021"
        },
        {
            "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": "770-786-0427",
            "fax_number": "770-385-9021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVINGTON MANOR NURSING HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CRUMP",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "GARY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-786-0427",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "11071744",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00265196A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Covington Dental Partners, LLC
• Covington Family Chiropractic LLC
• Covington Family Dentistry LLC
• Covington Hearing Associates, LLC
• Covington Manor Nursing Home LLC (Covington Manor Nursing Home)
• Covington One Medical,LLC
• Covington Women's Health Specialist (Cathy Larrimore, MD and Associates)
• Melanie Marie Cox
• Nathan R Craver, PTA
• Jace John Crawford, PA-C

• Skilled Nursing Facility in Covington, GA
• Providers in Covington, 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 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.