Provider Demographics
NPI:1043216211
Name:CHC - HARALSON NURSING & REHAB CTR, LLC
Entity Type:Organization
Organization Name:CHC - HARALSON NURSING & REHAB CTR, LLC
Other - Org Name:HARALSON NURSING & REHABILITATION CENTER.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:STARER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-390-4300
Mailing Address - Street 1:315 FIELD ST
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-2105
Mailing Address - Country:US
Mailing Address - Phone:770-537-4482
Mailing Address - Fax:770-537-1279
Practice Address - Street 1:315 FIELD ST
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-2105
Practice Address - Country:US
Practice Address - Phone:770-537-4482
Practice Address - Fax:770-537-1279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10711754314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00141325AMedicaid
GA00141325AMedicaid