Provider Demographics
NPI:1598798696
Name:HCC - HEALTHCARE OF BUCKHEAD, LLC
Entity Type:Organization
Organization Name:HCC - HEALTHCARE OF BUCKHEAD, LLC
Other - Org Name:BUCKHEAD HEALTH & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRIVACY OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LOUANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-619-0866
Mailing Address - Street 1:925 N POINT PKWY
Mailing Address - Street 2:SUITE 440
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5210
Mailing Address - Country:US
Mailing Address - Phone:770-619-0866
Mailing Address - Fax:770-870-2892
Practice Address - Street 1:54 PEACHTREE PARK DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1304
Practice Address - Country:US
Practice Address - Phone:404-351-6041
Practice Address - Fax:404-355-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10591719314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
115110Medicare ID - Type Unspecified