Provider Demographics
NPI:1043334782
Name:SOUTHERN CRESCENT REHABILITATION AND RETIREMENT COMMUNITY, INC
Entity Type:Organization
Organization Name:SOUTHERN CRESCENT REHABILITATION AND RETIREMENT COMMUNITY, INC
Other - Org Name:SOUTHERN CRESCENT TBI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:ABID
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-565-7710
Mailing Address - Street 1:2125 HWY 42N
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4733
Mailing Address - Country:US
Mailing Address - Phone:678-565-7710
Mailing Address - Fax:678-565-9723
Practice Address - Street 1:2125 HIGHWAY 42 N
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-4733
Practice Address - Country:US
Practice Address - Phone:678-565-7710
Practice Address - Fax:678-565-9723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health