Healthcare Provider Details

I. General information

NPI: 1649674839
Provider Name (Legal Business Name): TREATED EXCELLENT HEALTHCARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 BRIDLE CREEK WAY
AUBURN GA
30011-4654
US

IV. Provider business mailing address

753 BRIDLE CREEK WAY
AUBURN GA
30011-4654
US

V. Phone/Fax

Practice location:
  • Phone: 209-418-7328
  • Fax: 404-585-3554
Mailing address:
  • Phone: 209-418-7328
  • Fax: 404-585-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL D FARMER
Title or Position: OWNER
Credential:
Phone: 209-418-7328