NPIMap

Organization Active NPI

PMR Georgia Holding, LLC

Doing business as Jencare Senior Medical Center Hammond Park

  • Non-Pharmacy Dispensing Site
  • Atlanta, GA
National Provider Identifier
1013661438
Registry record updated Oct 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
PMR GEORGIA HOLDING, LLC
Doing business as
Jencare Senior Medical Center Hammond Park
Practice address
2720 Metropolitan Pkwy SW
Atlanta, GA 30315-7914
Phone
(404) 905-9200
Fax
(404) 815-4330
NPI assigned
Feb 4, 2022
Organization subpart
Yes
Parent organization
PMR GEORGIA HOLDING, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 3, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary Chen
Title
Authorized Official
Phone
(305) 628-6117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

2720 Metropolitan Pkwy SW
Atlanta, GA 30315-7914

Mailing address

1395 NW 167TH St
Miami Gardens, FL 33169-5710
Phone (305) 628-6117

Other names 1

  • JENCARE SENIOR MEDICAL CENTER HAMMOND PARK Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2253544Jencare Senior Medical Center - Hammond Park2720 Metropolitan Parkway, SW, Atlanta, GA 30315Certificate of waiverFeb 21, 2028

National Provider Directory

National Provider Directory
Tax ID family
PMR Georgia Holding LLC4 organizations share this tax ID, including this one
Part of
PMR Georgia Holding LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664755200000",
    "number": "1013661438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695710",
            "telephone_number": "305-628-6117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 METROPOLITAN PKWY SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303157914",
            "telephone_number": "404-905-9200",
            "fax_number": "404-815-4330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PMR GEORGIA HOLDING, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PMR GEORGIA HOLDING, LLC",
        "enumeration_date": "2022-02-04",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A",
        "authorized_official_last_name": "CHEN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "305-628-6117"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JENCARE SENIOR MEDICAL CENTER HAMMOND PARK",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "JENCARE SENIOR MEDICAL CENTER HAMMOND PARK",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.