1790005403 NPI number — WEST COBB HEALTH ADN REHAB CENTER

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 1790005403 NPI number — WEST COBB HEALTH ADN REHAB CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST COBB HEALTH ADN REHAB CENTER
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:
Provider Other Organization Name Type Code:
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:
1790005403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3901 MARY ELIZA TRCE NW
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30064-1094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-485-3255
Provider Business Mailing Address Fax Number:
770-693-7804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3901 MARY ELIZA TRCE NW
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30064-1094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-485-3255
Provider Business Practice Location Address Fax Number:
770-693-7804
Provider Enumeration Date:
06/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPAGNA
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
678-699-3238

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CHIR007533 , 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)





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