Healthcare Provider Details

I. General information

NPI: 1043216211
Provider Name (Legal Business Name): CHC - HARALSON NURSING & REHAB CTR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 FIELD ST
BREMEN GA
30110-2105
US

IV. Provider business mailing address

315 FIELD ST
BREMEN GA
30110-2105
US

V. Phone/Fax

Practice location:
  • Phone: 770-537-4482
  • Fax: 770-537-1279
Mailing address:
  • Phone: 770-537-4482
  • Fax: 770-537-1279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10711754
License Number StateGA

VIII. Authorized Official

Name: MR. MITCHELL STARER
Title or Position: MANAGER
Credential:
Phone: 914-390-4300