Provider Demographics
NPI:1386648962
Name:A G RHODES HOME INC
Entity Type:Organization
Organization Name:A G RHODES HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEKE
Authorized Official - Middle Name:GAVIN
Authorized Official - Last Name:CATEAU
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:404-688-6731
Mailing Address - Street 1:350 BOULEVARD SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312
Mailing Address - Country:US
Mailing Address - Phone:404-688-6731
Mailing Address - Fax:404-659-8639
Practice Address - Street 1:350 BOULEVARD S.E.
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-3352
Practice Address - Country:US
Practice Address - Phone:404-688-6731
Practice Address - Fax:404-659-8639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA163WA2000X, 376G00000X
GA1060142314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Multi-Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Multi-Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0877680001Medicare NSC
GA000140005AMedicaid
GA115275Medicare Oscar/Certification