Provider Demographics
NPI:1609648773
Name:CEDAR COMMUNITIES AT STONE MOUNTAIN, LLC
Entity Type:Organization
Organization Name:CEDAR COMMUNITIES AT STONE MOUNTAIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSL
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TERZULLI
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:646-428-3270
Mailing Address - Street 1:1225 FRANKLIN AVE STE 325
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1693
Mailing Address - Country:US
Mailing Address - Phone:646-428-3270
Mailing Address - Fax:
Practice Address - Street 1:1745 PARKE PLAZA CIR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3498
Practice Address - Country:US
Practice Address - Phone:770-689-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care