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NPI Code Detail

MEDICARE: DELMAR GARDENS OF SMYRNA, LLC

MEDICARE: DELMAR GARDENS OF SMYRNA, 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
1314000000XSkilled Nursing Facility1-033-1830GA

Other Identifiers

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

General Provider Information

NPI Number : 1194711606
Entity Type Code : Organization
Provider Name (Legal Business Name) : DELMAR GARDENS OF SMYRNA, LLC
Provider Business Mailing Address
First Line : 14805 N OUTER 40 RD
Second Line : SUITE 300
City : CHESTERFIELD
State : MO
Zip : 63017-6060
Country : US
Telephone Number : 636-733-7000
Fax Number : 636-733-7010
Provider Business Practice Location Address
First Line : 404 KING SPRINGS VILLAGE PKWY SE
Second Line :
City : SMYRNA
State : GA
Zip : 30082-4240
Country : US
Telephone Number : 770-432-4444
Fax Number : 770-319-9129
Authorized Official
Title or Position : TREASURER
Name : MR. GAIL LEE HARTMANN
Credential :
Telephone Number : 636-733-7000
Provider Enumeration Date : 09/21/2005
Last Update Date : 03/03/2015

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