Healthcare Provider Details

I. General information

NPI: 1992715411
Provider Name (Legal Business Name): LIVING CENTERS-SOUTHEAST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE RAVINIA DRIVE, SUITE 1250
ATLANTA GA
30346
US

IV. Provider business mailing address

ONE RAVINIA DRIVE, SUITE 1250
ATLANTA GA
30346
US

V. Phone/Fax

Practice location:
  • Phone: 678-443-6772
  • Fax: 678-443-7013
Mailing address:
  • Phone: 678-443-6772
  • Fax: 678-443-7013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2516
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALF535999
License Number StateVA

VIII. Authorized Official

Name: DEVIN M EHRLICH
Title or Position: SVP
Credential:
Phone: 678-443-6772