MEDICARE: RELIABLE HEALTH & REHAB AT LAKEWOOD, 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

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	:	1437260056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIABLE HEALTH & REHAB AT LAKEWOOD, LLC

Provider Business Mailing Address
First Line	:	3301 LAKEWOOD AVE SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-5047
Country	:	US
Telephone Number	:	770-548-9398
Fax Number	:	706-378-0507

Provider Business Practice Location Address
First Line	:	3301 LAKEWOOD AVE SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-5047
Country	:	US
Telephone Number	:	770-548-9398
Fax Number	:	706-378-0507

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. ANDREW J. MORRIS
Credential	:
Telephone Number	:	706-378-0940

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	05/01/2008

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