Provider Demographics
NPI:1851530554
Name:SOUTHERN CRESCENT REHABILITATION AND RETIREMENT COMMUNITY, INC
Entity Type:Organization
Organization Name:SOUTHERN CRESCENT REHABILITATION AND RETIREMENT COMMUNITY, INC
Other - Org Name:SOUTHERN CRESCENT TBI CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:EL SAWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-378-9774
Mailing Address - Street 1:2125 HIGHWAY 42 N
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4733
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2125 HIGHWAY 42 N
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-4733
Practice Address - Country:US
Practice Address - Phone:678-565-7710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075-004282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital