Provider Demographics
NPI:1609048792
Name:ARROWHEAD OPERATOR LLC
Entity Type:Organization
Organization Name:ARROWHEAD OPERATOR LLC
Other - Org Name:ARROWHEAD HEALTH AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMNIE
Authorized Official - Middle Name:CHAN
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-478-3013
Mailing Address - Street 1:239 ARROWHEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1101
Mailing Address - Country:US
Mailing Address - Phone:770-478-3013
Mailing Address - Fax:770-478-3446
Practice Address - Street 1:239 ARROWHEAD BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1101
Practice Address - Country:US
Practice Address - Phone:770-478-3013
Practice Address - Fax:770-478-3446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-031-1409314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000143162AMedicaid
115539Medicare Oscar/Certification