Healthcare Provider Details

I. General information

NPI: 1164848396
Provider Name (Legal Business Name): ABERCORN REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 ABERCORN ST
SAVANNAH GA
31419-1908
US

IV. Provider business mailing address

5887 GLENRIDGE DR SUITE 150
ATLANTA GA
30328-5574
US

V. Phone/Fax

Practice location:
  • Phone: 912-925-4402
  • Fax: 912-920-4756
Mailing address:
  • Phone: 404-574-2100
  • Fax: 404-574-2105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-025-2037
License Number StateGA

VIII. Authorized Official

Name: MR. R. MARK CRONQUIST
Title or Position: MANAGER
Credential:
Phone: 404-574-2100