Healthcare Provider Details

I. General information

NPI: 1124024377
Provider Name (Legal Business Name): CHC CARROLLTON 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

4 WEST RED OAK LANE SUITE 201
WHITE PLAINS NY
10604-3603
US

IV. Provider business mailing address

2327 N HIGHWAY 27
CARROLLTON GA
30117-6701
US

V. Phone/Fax

Practice location:
  • Phone: 914-390-4377
  • Fax: 914-253-7507
Mailing address:
  • Phone: 770-748-4116
  • Fax: 770-748-2932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10221753
License Number StateGA

VIII. Authorized Official

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