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General NPI Number Information
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NPI Number | 1942780416
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Entity Type | Organization
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Legal Business Name | LENORA CHURCH ROAD PROPERTY - SNF, LLC
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 3000 LENORA CHURCH RD
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City | SNELLVILLE
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State | GA
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Zip | 30078-3622
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Country | US
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Telephone | 770-972-2040
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 OLD ALABAMA RD STE 119-403
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City | ALPHARETTA
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State | GA
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Zip | 30022-5860
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Country | US
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Telephone | 404-282-4755
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | DAREN DOUSTON
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Credential |
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Telephone | 404-282-4755
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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 |
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License Number State |
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