Provider Demographics
NPI:1972655611
Name:ADK POWDER SPRINGS OPERATOR, LLC
Entity Type:Organization
Organization Name:ADK POWDER SPRINGS OPERATOR, LLC
Other - Org Name:POWDER SPRINGS NURSING & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
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 1:3460 POWDER SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-2322
Mailing Address - Country:US
Mailing Address - Phone:770-439-9199
Mailing Address - Fax:770-439-0454
Practice Address - Street 1:3460 POWDER SPRINGS RD
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-2322
Practice Address - Country:US
Practice Address - Phone:770-439-9199
Practice Address - Fax:770-439-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10331883314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00530824AMedicaid
GA00530824AMedicaid