Provider Demographics
NPI:1205200797
Name:FC MIDLANDS GARDEN CITY, LLC
Entity Type:Organization
Organization Name:FC MIDLANDS GARDEN CITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-754-9660
Mailing Address - Street 1:3500 LENOX ROAD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326
Mailing Address - Country:US
Mailing Address - Phone:770-754-9660
Mailing Address - Fax:
Practice Address - Street 1:11951 GRANDHAVEN DR
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7843
Practice Address - Country:US
Practice Address - Phone:843-357-0200
Practice Address - Fax:843-652-2694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility