Provider Demographics
NPI:1588660682
Name:CHC -WOODSTOCK NURSING & REHAB CENTER, LLC
Entity Type:Organization
Organization Name:CHC -WOODSTOCK NURSING & REHAB CENTER, LLC
Other - Org Name:WOODSTOCK NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:STARER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-390-4300
Mailing Address - Street 1:105 ARNOLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-5027
Mailing Address - Country:US
Mailing Address - Phone:770-926-0016
Mailing Address - Fax:770-926-0969
Practice Address - Street 1:105 ARNOLD MILL RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-5027
Practice Address - Country:US
Practice Address - Phone:770-926-0016
Practice Address - Fax:977-092-6096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10281755314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00171212AMedicaid
GA00171212AMedicaid