SCG LAKE COUNTRY LLC (NPI# 1033110457) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033110457 |
| Entity Type | Organization |
| Organization Name | SCG LAKE COUNTRY LLC |
| Other Organization Name | LAKE COUNTRY NURSING CENTER |
| Practice Address |
401 C E Colston Dr Marietta OK 73448-1230 |
| Mailing Address |
1240 Marbella Plaza Dr. Tampa FL 33619-7905 |
| Practice Telephone | 5802763318 |
| Practice Fax Number | 5802762100 |
| Mailing Telephone | 8133412700 |
| Mailing Fax Number | 8136760127 |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2010-01-22 |
| Authorized Official Name | MR. ROBERT DANIEL VAUGHAN (PRESIDENT) |
| Authorized Official Telephone | 8133412700 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | NH4301-4301 | OK | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100776270A | 05 |
| Other Name | Type Code |
|---|---|
| Lake Country Nursing Center | Doing Business As Name - Organization |
| Street Address |
401 C E COLSTON DR |
| City | MARIETTA |
| State | OK |
| Zip Code | 73448-1230 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992958805 | Christi Lynn Hallum | Counselor | 200 Wanda Street, Marietta, OK 73448 | 2008-10-23 |
| 1831340041 | Shelly Renee Cumberledge | Counselor | 404 E. Pine St, Marietta, OK 73448 | 2008-10-07 |
| 1760528970 | Mental Health Services of Southern Oklahoma | Case Management | 200 Wanda St, Marietta, OK 73448 | 2007-01-29 |
| 1083811871 | Doris Jean Petty | Registered Nurse | 200 Wanda, Marietta, OK 73448 | 2007-06-27 |
| 1295871499 | Mental Health Services of Southern Oklahoma | Clinic/Center | 200 Wanda St, Marietta, OK 73448 | 2007-01-29 |
| 1114093002 | Charles Reid Schnorrenberg | Pharmacist | 300 S Highway 77, Marietta, OK 73448 | 2006-11-24 |
| 1588866107 | Pamela Rae Lynn | Counselor | 200 Wanda, Marietta, OK 73448-0506 | 2007-06-05 |
| 1912944646 | Love County Health Center | General Acute Care Hospital | 300 Wanda Steet, Marietta, OK 73448-1200 | 2006-06-01 |
| 1649221557 | Love County Health Center | General Acute Care Hospital | 300 Wanda Street, Marietta, OK 73448-1200 | 2006-05-15 |
| 1134179641 | Tad Alan Hall | Physician Assistant | 300 Wanda St, Marietta, OK 73448-1200 | 2006-05-12 |
| Find all providers in zip 73448 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053797340 | C.r. of Autumn Breeze, LLC | Skilled Nursing Facility | 1480 Sandtown Rd Sw, Marietta, GA 30008-3821 | 2015-08-10 |
| 1629312079 | Sundance | Skilled Nursing Facility | 145 Cox Farm Rd Nw, Marietta, GA 30064-5059 | 2012-11-23 |
| 1639241284 | Marietta Care, LLC | Skilled Nursing Facility | 400 N 7th St, Marietta, OH 45750-2024 | 2006-11-15 |
| 1184730913 | Marietta Healthcare, LLC | Skilled Nursing Facility | 117 Bartlett St, Marietta, OH 45750-2683 | 2006-08-22 |
| 1295768497 | Hcc Healthcare of Marietta, LLC | Skilled Nursing Facility | 811 Kennesaw Avenue, Marietta, GA 30060 | 2006-07-09 |
| 1164466942 | Heartland of Marietta Oh, LLC | Skilled Nursing Facility | 2501 State Route 60, Marietta, OH 45750-1271 | 2006-06-15 |
| 1619914520 | Manor Care of Marietta Ga LLC | Skilled Nursing Facility | 4360 Johnson Ferry Pl, Marietta, GA 30068-2016 | 2006-05-31 |
| 1053366336 | Mt. Kenn Nursing, LLC | Skilled Nursing Facility | 1480 Sandtown Road, Marietta, GA 30008-3821 | 2006-05-24 |
| 1700838265 | Ggnsc Marietta LLC | Skilled Nursing Facility | 613 Roselane St Nw, Marietta, GA 30060-6940 | 2006-05-16 |
| 1447219696 | Mpi Management, Inc | Skilled Nursing Facility | 2906 Geer Hwy, Marietta, SC 29661-9517 | 2006-03-17 |
| Find all providers in MARIETTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.