Provider Demographics
NPI:1083680094
Name:EASTLAKE ARBOR HEALTH CARE, INC.
Entity Type:Organization
Organization Name:EASTLAKE ARBOR HEALTH CARE, INC.
Other - Org Name:EAST LAKE ARBOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:KARSCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-939-8720
Mailing Address - Street 1:304 FIFTH AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4812
Mailing Address - Country:US
Mailing Address - Phone:404-373-6231
Mailing Address - Fax:404-373-6813
Practice Address - Street 1:304 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-4812
Practice Address - Country:US
Practice Address - Phone:404-373-6231
Practice Address - Fax:404-373-6813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10441435314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000140137AMedicaid
GA000140137AMedicaid