MEDICARE: CS ASSISTED LIVING INC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1629339445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CS ASSISTED LIVING INC

Provider Business Mailing Address
First Line	:	2151 SKYLAND COVE LANE
Second Line	:
City	:	SHELLVILLE GA
State	:	GA
Zip	:	30078
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2151 SKYLAND COVE LANE
Second Line	:
City	:	SHELLVILLE GA
State	:	GA
Zip	:	30078
Country	:	US
Telephone Number	:	404-457-8950
Fax Number	:

Authorized Official
Title or Position	:	CEO/FOUNDER
Name	:	MR. CALVIN SCOTT
Credential	:
Telephone Number	:	404-578-9850

Provider Enumeration Date	:	06/07/2012
Last Update Date	:	06/07/2012

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