Provider Demographics
NPI:1811035124
Name:ATLANTA NURSING HOMES INC
Entity Type:Organization
Organization Name:ATLANTA NURSING HOMES INC
Other - Org Name:DBA GOLDEN VILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:JESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-796-0290
Mailing Address - Street 1:1104 S WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:TX
Mailing Address - Zip Code:75551-3246
Mailing Address - Country:US
Mailing Address - Phone:903-796-0290
Mailing Address - Fax:903-796-3976
Practice Address - Street 1:1104 S WILLIAM ST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551-3246
Practice Address - Country:US
Practice Address - Phone:903-796-0290
Practice Address - Fax:903-796-3976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1178763140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000437602Medicaid
TX675490Medicare Oscar/Certification