Provider Demographics
NPI:1376702498
Name:WENDER & ROBERTS ASSISTED LIVING
Entity Type:Organization
Organization Name:WENDER & ROBERTS ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:COGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-992-7300
Mailing Address - Street 1:10930 CRABAPPLE RD
Mailing Address - Street 2:SUITE 7 B
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5813
Mailing Address - Country:US
Mailing Address - Phone:770-992-7300
Mailing Address - Fax:
Practice Address - Street 1:10930 CRABAPPLE RD
Practice Address - Street 2:SUITE 7 B
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5813
Practice Address - Country:US
Practice Address - Phone:770-992-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0094463336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy