Provider Demographics
NPI:1760488852
Name:CHC -UNIVERSITY NURSING & REHAB CTR, LLC
Entity Type:Organization
Organization Name:CHC -UNIVERSITY NURSING & REHAB CTR, LLC
Other - Org Name:UNIVERSITY NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
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 1:180 EPPS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-3312
Mailing Address - Country:US
Mailing Address - Phone:706-549-5382
Mailing Address - Fax:706-613-0991
Practice Address - Street 1:180 EPPS BRIDGE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-3312
Practice Address - Country:US
Practice Address - Phone:706-549-5382
Practice Address - Fax:706-613-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10291762314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00140533AMedicaid
GA115467Medicare Oscar/Certification