Provider Demographics
NPI:1073647582
Name:BELMONT VILLAGE
Entity Type:Organization
Organization Name:BELMONT VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL VP-EAST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-463-1741
Mailing Address - Street 1:4315 JOHNS CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6048
Mailing Address - Country:US
Mailing Address - Phone:770-813-9505
Mailing Address - Fax:770-813-0380
Practice Address - Street 1:4315 JOHNS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6048
Practice Address - Country:US
Practice Address - Phone:770-813-9505
Practice Address - Fax:770-813-0380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
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