MEDICARE: A.G. RHODES EXTENDACARE, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251G00000X	Community Based Hospice Care Agency
2	251V00000X	Voluntary or Charitable Agency
3	261QA0600X	Adult Day Care Clinic/Center
4	261QP2000X	Physical Therapy Clinic/Center
5	315D00000X	Inpatient Hospice
6	343900000X	Non-emergency Medical Transport (VAN)
7	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1891879813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A.G. RHODES EXTENDACARE, INC.

Provider Business Mailing Address
First Line	:	3715 NORTHSIDE PKWY NW
Second Line	:	BUILDING 400, SUITE 305
City	:	ATLANTA
State	:	GA
Zip	:	30327-2806
Country	:	US
Telephone Number	:	404-949-3830
Fax Number	:	404-949-3831

Provider Business Practice Location Address
First Line	:	3715 NORTHSIDE PKWY NW
Second Line	:	BUILDING 400, SUITE 305
City	:	ATLANTA
State	:	GA
Zip	:	30327-2806
Country	:	US
Telephone Number	:	404-949-3830
Fax Number	:	404-949-3831

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MR. RUSSELL JOSEPH WILLIAMS
Credential	:
Telephone Number	:	404-949-3830

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	09/11/2025

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