Provider Demographics
NPI:1821091463
Name:A. G. RHODES HOME INC. AT WESLEY WOODS
Entity Type:Organization
Organization Name:A. G. RHODES HOME INC. AT WESLEY WOODS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:T
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:404-315-0900
Mailing Address - Street 1:1819 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-4021
Mailing Address - Country:US
Mailing Address - Phone:404-315-0900
Mailing Address - Fax:678-420-2027
Practice Address - Street 1:1819 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-4021
Practice Address - Country:US
Practice Address - Phone:404-315-0900
Practice Address - Fax:678-420-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-044-1421314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00040818AMedicaid
GA115002Medicare Oscar/Certification
1297980001Medicare NSC