Healthcare Provider Details

I. General information

NPI: 1669060968
Provider Name (Legal Business Name): POWDER SPRINGS OPERATING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 12/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 POWDER SPRINGS RD
POWDER SPRINGS GA
30127-2322
US

IV. Provider business mailing address

211 BLVD OF THE AMERICAS SUITE 206
LAKEWOOD NJ
08701
US

V. Phone/Fax

Practice location:
  • Phone: 770-439-9199
  • Fax:
Mailing address:
  • Phone: 470-737-0111
  • 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: SHLOMO E HELLER
Title or Position: CEO, EMPIRE CARE CENTERS LLC
Credential:
Phone: 470-737-0111