Provider Demographics
NPI:1124024377
Name:CHC CARROLLTON NURSING & REHAB CTR, LLC
Entity Type:Organization
Organization Name:CHC CARROLLTON NURSING & REHAB CTR, LLC
Other - Org Name:CARROLLTON NURSING & REHAB CENTER.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:STARER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-390-4300
Mailing Address - Street 1:2327 N HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-6701
Mailing Address - Country:US
Mailing Address - Phone:770-748-4116
Mailing Address - Fax:770-748-2932
Practice Address - Street 1:4 WEST RED OAK LANE
Practice Address - Street 2:SUITE 201
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-3603
Practice Address - Country:US
Practice Address - Phone:914-390-4377
Practice Address - Fax:914-253-7507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10221753314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00059661AMedicaid
GA00059661AMedicaid