Provider Demographics
NPI:1710068564
Name:ADK BONTERRA PARKVIEW, LLC
Entity Type:Organization
Organization Name:ADK BONTERRA PARKVIEW, LLC
Other - Org Name:LEGACY NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-869-5116
Mailing Address - Street 1:460 AUBURN AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1504
Mailing Address - Country:US
Mailing Address - Phone:404-523-1613
Mailing Address - Fax:404-681-4536
Practice Address - Street 1:460 AUBURN AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1504
Practice Address - Country:US
Practice Address - Phone:404-523-1613
Practice Address - Fax:404-681-4536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005657LGB314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000141831AMedicaid
GA000141831AMedicaid