Healthcare Provider Details

I. General information

NPI: 1003800343
Provider Name (Legal Business Name): GEORGIA-ATKISON SNF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 DURFEE AVE
EL MONTE CA
91732-2505
US

IV. Provider business mailing address

3825 DURFEE AVE
EL MONTE CA
91732-2505
US

V. Phone/Fax

Practice location:
  • Phone: 626-444-2535
  • Fax: 626-444-7605
Mailing address:
  • Phone: 626-444-2535
  • Fax: 626-444-7605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number950000068
License Number StateCA

VIII. Authorized Official

Name: MR. ELI QUINONES
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 626-444-2535