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General NPI Number Information
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NPI Number | 1972655611
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Entity Type | Organization
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Legal Business Name | ADK POWDER SPRINGS OPERATOR, LLC
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 3460 POWDER SPRINGS RD
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-2322
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Country | US
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Telephone | 770-439-9199
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Fax | 770-439-0454
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Provider Business Mailing Address
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Address Line | 3460 POWDER SPRINGS RD
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-2322
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Country | US
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Telephone | 770-439-9199
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Fax | 770-439-0454
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Authorized Official
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Title or Position | COO
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Name | MR. DAVID RUBENSTEIN
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Credential |
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Telephone | 678-869-5116
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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 | 10331883
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License Number State | GA
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