Provider Demographics
NPI:1093715625
Name:CEDAR SPRINGS HEALTH CARE & REHAB LLC
Entity Type:Organization
Organization Name:CEDAR SPRINGS HEALTH CARE & REHAB LLC
Other - Org Name:THE COTTAGES AT ROCKMART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:706-378-0940
Mailing Address - Street 1:750 GOODYEAR AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-2555
Mailing Address - Country:US
Mailing Address - Phone:770-748-3622
Mailing Address - Fax:770-748-0415
Practice Address - Street 1:750 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153-2555
Practice Address - Country:US
Practice Address - Phone:770-748-3622
Practice Address - Fax:770-748-0415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-115-1808314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00140544AMedicaid
GA00140544AMedicaid