MEDICARE: GREEN ACRES CARE CENTER 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

General Provider Information

NPI Number	:	1215753819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN ACRES CARE CENTER LLC

Provider Business Mailing Address
First Line	:	1400 HOGANSVILLE RD
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30241-1422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 HOGANSVILLE RD
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30241-1422
Country	:	US
Telephone Number	:	706-803-7390
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ZACK ROSENBERG
Credential	:
Telephone Number	:	732-335-6951

Provider Enumeration Date	:	11/27/2024
Last Update Date	:	11/27/2024

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