Provider Demographics
NPI:1124004940
Name:LTC CONSULTING, L.P.
Entity Type:Organization
Organization Name:LTC CONSULTING, L.P.
Other - Org Name:ROCKDALE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-992-0441
Mailing Address - Street 1:1510 RENAISSANCE DR NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3895
Mailing Address - Country:US
Mailing Address - Phone:770-483-4480
Mailing Address - Fax:
Practice Address - Street 1:1510 RENAISSANCE DR NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3895
Practice Address - Country:US
Practice Address - Phone:770-483-4480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-122-1567314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA686513389AMedicaid
GA000838252AMedicaid
GA115670Medicare Oscar/Certification