MEDICARE: ADK BONTERRA PARKVIEW, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	10777	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053492801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADK BONTERRA PARKVIEW, LLC

Provider Business Mailing Address
First Line	:	2801 FELTON DR
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-3605
Country	:	US
Telephone Number	:	404-767-7591
Fax Number	:	404-765-0547

Provider Business Practice Location Address
First Line	:	2801 FELTON DR
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-3605
Country	:	US
Telephone Number	:	404-767-7591
Fax Number	:	404-765-0547

Authorized Official
Title or Position	:	VICE PRESIDENT MIS
Name	:	CAROL J GROEBER
Credential	:
Telephone Number	:	937-964-8974

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	03/16/2011

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