Provider Demographics
NPI:1558753665
Name:CHELSEY PARK HEALTH & REHABILITATION LLC
Entity Type:Organization
Organization Name:CHELSEY PARK HEALTH & REHABILITATION LLC
Other - Org Name:CHELSEY PARK HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-482-3000
Mailing Address - Street 1:200 MOUNTAIN PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533
Mailing Address - Country:US
Mailing Address - Phone:706-482-3000
Mailing Address - Fax:
Practice Address - Street 1:200 MOUNTAIN PARK DRIVE
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533
Practice Address - Country:US
Practice Address - Phone:706-482-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003165720AMedicaid
115724Medicare Oscar/Certification