Provider Demographics
NPI:1033172291
Name:ALTA CORPORATION DBA GEORGIA LIVING CENTER
Entity Type:Organization
Organization Name:ALTA CORPORATION DBA GEORGIA LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSHING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-892-3193
Mailing Address - Street 1:182 HEAD AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAPOOSA
Mailing Address - State:GA
Mailing Address - Zip Code:30176-1259
Mailing Address - Country:US
Mailing Address - Phone:770-574-2629
Mailing Address - Fax:770-574-8098
Practice Address - Street 1:182 HEAD AVE
Practice Address - Street 2:
Practice Address - City:TALLAPOOSA
Practice Address - State:GA
Practice Address - Zip Code:30176-1259
Practice Address - Country:US
Practice Address - Phone:770-574-2629
Practice Address - Fax:770-574-8098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility