Healthcare Provider Details

I. General information

NPI: 1962049338
Provider Name (Legal Business Name): GA HC REIT II INDIAN TRAIL ALF TRS SUB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 07/22/2025
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5306 SECREST SHORTCUT RD
MONROE NC
28110-9173
US

IV. Provider business mailing address

500 N HURSTBOURNE PKWY SUITE 200
LOUISVILLE KY
40222-3301
US

V. Phone/Fax

Practice location:
  • Phone: 212-547-2600
  • Fax:
Mailing address:
  • Phone: 877-483-6827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTIAN N. CUMMINGS
Title or Position: PRESIDENT
Credential:
Phone: 877-483-6827