MEDICARE: A G RHODES HOME 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	1060142	GA
2	163WA2000X	Administrator Registered Nurse		GA
3	376G00000X	Nursing Home Administrator		GA

General Provider Information

NPI Number	:	1386648962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A G RHODES HOME INC

Provider Business Mailing Address
First Line	:	350 BOULEVARD SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312
Country	:	US
Telephone Number	:	404-688-6731
Fax Number	:	404-659-8639

Provider Business Practice Location Address
First Line	:	350 BOULEVARD S.E.
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-3352
Country	:	US
Telephone Number	:	404-688-6731
Fax Number	:	404-659-8639

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. DEKE GAVIN CATEAU
Credential	:	N.H.A.
Telephone Number	:	404-688-6731

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	10/06/2016

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Directions to “A G RHODES HOME INC ” Practice Location

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