Healthcare Provider Details

I. General information

NPI: 1316718802
Provider Name (Legal Business Name): TOWER ROAD POST ACUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 TOWER RD NE
MARIETTA GA
30060-6947
US

IV. Provider business mailing address

26 TOWER RD NE
MARIETTA GA
30060-6947
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-8913
  • Fax:
Mailing address:
  • Phone: 770-422-8913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH FUNK
Title or Position: MEMBER OF LLC
Credential:
Phone: 478-200-0300