=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093441883
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATHENS POST ACUTE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2022
-----------------------------------------------------
Last Update Date | 11/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 545 W EUCLID AVE
-----------------------------------------------------
City | DELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32720-6771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-734-9085
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 545 W EUCLID AVE
-----------------------------------------------------
City | DELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32720-6771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-734-9085
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LEGAL COUNSEL
-----------------------------------------------------
Name | SCOTT H TANNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 949-430-5178
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------