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General NPI Number Information
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NPI Number | 1043216211
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Entity Type | Organization
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Legal Business Name | CHC - HARALSON NURSING & REHAB CTR, LLC
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 315 FIELD ST
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City | BREMEN
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State | GA
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Zip | 30110-2105
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Country | US
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Telephone | 770-537-4482
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Fax | 770-537-1279
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Provider Business Mailing Address
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Address Line | 315 FIELD ST
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City | BREMEN
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State | GA
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Zip | 30110-2105
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Country | US
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Telephone | 770-537-4482
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Fax | 770-537-1279
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Authorized Official
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Title or Position | MANAGER
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Name | MR. MITCHELL STARER
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Credential |
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Telephone | 914-390-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 10711754
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License Number State | GA
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