MEDICARE: ADK BONTERRA PARKVIEW, 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	005657LGB	GA

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	:	1710068564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADK BONTERRA PARKVIEW, LLC

Provider Business Mailing Address
First Line	:	460 AUBURN AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-1504
Country	:	US
Telephone Number	:	404-523-1613
Fax Number	:	404-681-4536

Provider Business Practice Location Address
First Line	:	460 AUBURN AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-1504
Country	:	US
Telephone Number	:	404-523-1613
Fax Number	:	404-681-4536

Authorized Official
Title or Position	:	COO
Name	:	DAVID RUBENSTEIN
Credential	:
Telephone Number	:	678-869-5116

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	04/24/2014

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