1609809706 NPI number — SALEM NURSING & REHAB CENTER OF AUGUSTA, INC.

Table of content: MICHAEL OSINAGA (NPI 1700459625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609809706 NPI number — SALEM NURSING & REHAB CENTER OF AUGUSTA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALEM NURSING & REHAB CENTER OF AUGUSTA, INC.
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:
AMARA HEALTH CARE & REHAB
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:
1609809706
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
925 N POINT PKWY
Provider Second Line Business Mailing Address:
SUITE 440
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30005-5210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-619-0866
Provider Business Mailing Address Fax Number:
770-870-2892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2021 SCOTT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30906-2539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-793-1057
Provider Business Practice Location Address Fax Number:
706-790-0786
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MITTLEIDER
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-619-0866

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  74952 , 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: 00140049A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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