Provider Demographics
NPI:1265011357
Name:CONYERS GA OPCO LLC
Entity Type:Organization
Organization Name:CONYERS GA OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, EMPIRE CARE CENTERS
Authorized Official - Prefix:
Authorized Official - First Name:SHLOMO
Authorized Official - Middle Name:E
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-737-0111
Mailing Address - Street 1:1420 MILSTEAD RD NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3823
Mailing Address - Country:US
Mailing Address - Phone:770-483-3902
Mailing Address - Fax:
Practice Address - Street 1:1420 MILSTEAD RD NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3823
Practice Address - Country:US
Practice Address - Phone:770-483-3902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility