MEDICARE: GEORGIA-ATKISON SNF, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	950000068	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003800343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA-ATKISON SNF, LLC

Provider Business Mailing Address
First Line	:	3825 DURFEE AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-2505
Country	:	US
Telephone Number	:	626-444-2535
Fax Number	:	626-444-7605

Provider Business Practice Location Address
First Line	:	3825 DURFEE AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-2505
Country	:	US
Telephone Number	:	626-444-2535
Fax Number	:	626-444-7605

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MR. ELI QUINONES
Credential	:
Telephone Number	:	626-444-2535

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	02/04/2014

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