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NPI Code Detail

MEDICARE: CHC - CHESTNUT RIDGE NURSING & REHAB CTR, LLC

MEDICARE: CHC - CHESTNUT RIDGE NURSING & REHAB CTR, 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 Facility10581759GA

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 : 1801892070
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHC - CHESTNUT RIDGE NURSING & REHAB CTR, LLC
Provider Business Mailing Address
First Line : 125 SAMARITAN DR
Second Line :
City : CUMMING
State : GA
Zip : 30040-2354
Country : US
Telephone Number : 770-889-0120
Fax Number : 770-887-5626
Provider Business Practice Location Address
First Line : 125 SAMARITAN DR
Second Line :
City : CUMMING
State : GA
Zip : 30040-2354
Country : US
Telephone Number : 770-889-0120
Fax Number : 770-887-5626
Authorized Official
Title or Position : AUTHORIZED REPRESENTATIVE
Name : MR. MITCHELL STARER
Credential :
Telephone Number : 914-390-4300
Provider Enumeration Date : 06/22/2005
Last Update Date : 04/17/2014

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