MEDICARE: ATRIUM 6555 TENANT, 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	310400000X	Assisted Living Facility	11264	LA

General Provider Information

NPI Number	:	1174522734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATRIUM 6555 TENANT, LLC

Provider Business Mailing Address
First Line	:	6555 PARK MANOR DR
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70003-3906
Country	:	US
Telephone Number	:	504-454-6635
Fax Number	:	504-454-6655

Provider Business Practice Location Address
First Line	:	6555 PARK MANOR DR
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70003-3906
Country	:	US
Telephone Number	:	504-454-6635
Fax Number	:	504-454-6655

Authorized Official
Title or Position	:	COO
Name	:	MR. ALEX PALEY
Credential	:
Telephone Number	:	914-390-4363

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	02/12/2008

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