MEDICARE: THE OAKS - CHRISTIAN CITY ASSISTED LIVING, 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1639312234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE OAKS - CHRISTIAN CITY ASSISTED LIVING, LLC

Provider Business Mailing Address
First Line	:	1626 JEURGENS CT
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30093-2219
Country	:	US
Telephone Number	:	770-279-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	7290 LESTER ROAD
Second Line	:
City	:	UNION CITY
State	:	GA
Zip	:	30291-2377
Country	:	US
Telephone Number	:	770-703-2667
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN AND CEO
Name	:	MR. NEIL L. PRUITT JR.
Credential	:
Telephone Number	:	770-279-6200

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	06/30/2014

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