1588660682 NPI number — CHC -WOODSTOCK NURSING & REHAB CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588660682 NPI number — CHC -WOODSTOCK NURSING & REHAB CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHC -WOODSTOCK NURSING & REHAB CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WOODSTOCK NURSING AND REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588660682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 ARNOLD MILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODSTOCK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30188-5027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-926-0016
Provider Business Mailing Address Fax Number:
770-926-0969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 ARNOLD MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30188-5027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-926-0016
Provider Business Practice Location Address Fax Number:
977-092-6096
Provider Enumeration Date:
06/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STARER
Authorized Official First Name:
MITCHELL
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
914-390-4300

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  10281755 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00171212A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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