Provider Demographics
NPI:1407908163
Name:ADK LAGRANGE OPERATOR, LLC
Entity Type:Organization
Organization Name:ADK LAGRANGE OPERATOR, LLC
Other - Org Name:LAGRANGE NURSING AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP MIS
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:GROEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-964-8974
Mailing Address - Street 1:2111 W POINT RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4047
Mailing Address - Country:US
Mailing Address - Phone:706-812-9293
Mailing Address - Fax:706-812-9353
Practice Address - Street 1:2111 W POINT RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4047
Practice Address - Country:US
Practice Address - Phone:706-812-9293
Practice Address - Fax:706-812-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11411885314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00270245AMedicaid
GA00270245AMedicaid