Provider Demographics
NPI:1306816780
Name:IHS AT BRIARCLIFF HAVEN INC
Entity Type:Organization
Organization Name:IHS AT BRIARCLIFF HAVEN INC
Other - Org Name:BRIARCLIFF HAVEN HEALTH & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-513-8738
Mailing Address - Street 1:1000 BRIARCLIFF ROAD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306
Mailing Address - Country:US
Mailing Address - Phone:404-875-6456
Mailing Address - Fax:404-874-4606
Practice Address - Street 1:1000 BRIARCLIFF ROAD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306
Practice Address - Country:US
Practice Address - Phone:404-875-6456
Practice Address - Fax:404-876-4606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10441316314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00140401AMedicaid
115531Medicare Oscar/Certification