MEDICARE: ATLANTA ASSOCIATION FOR CONVALESCENT AGED PERSONS, INC.

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		GA

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	:	1174519326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA ASSOCIATION FOR CONVALESCENT AGED PERSONS, INC.

Provider Business Mailing Address
First Line	:	1821 ANDERSON AVE NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30314-1835
Country	:	US
Telephone Number	:	404-794-2477
Fax Number	:	404-799-9876

Provider Business Practice Location Address
First Line	:	1821 ANDERSON AVE NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30314-1835
Country	:	US
Telephone Number	:	404-794-2477
Fax Number	:	404-799-9876

Authorized Official
Title or Position	:	PRESIDENT /CEO
Name	:	MR. BETH LAXTON JR.
Credential	:
Telephone Number	:	678-420-2904

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	07/21/2022

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