CHC - Haralson Nursing & Rehab Ctr, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

10711754 Issued in GA

Legal business name

CHC - HARALSON NURSING & REHAB CTR, LLC

Practice address

315 Field St
Bremen, GA 30110-2105

Phone

(770) 537-4482

Fax

(770) 537-1279

NPI assigned

Jun 22, 2005

Organization subpart

No

Name

Mr. Mitchell Starer

Title

Manager

Phone

(914) 390-4300

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

• Haralson Cypress LLC

  • Skilled Nursing Facility
  • Bremen, GA
  • NPI 1356762322
  NPD tax ID

Tax ID family

CHC - Haralson Nursing Rehab Ctr LLC (2 organizations share this tax ID)

• Haralson Nursing & Rehabilitation Center. Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 21, 2014.

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395360000000",
    "number": "1043216211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 FIELD ST",
            "city": "BREMEN",
            "state": "GA",
            "postal_code": "301102105",
            "telephone_number": "770-537-4482",
            "fax_number": "770-537-1279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 FIELD ST",
            "city": "BREMEN",
            "state": "GA",
            "postal_code": "301102105",
            "telephone_number": "770-537-4482",
            "fax_number": "770-537-1279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHC - HARALSON NURSING & REHAB CTR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-22",
        "last_updated": "2014-03-21",
        "status": "A",
        "authorized_official_last_name": "STARER",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "914-390-4300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "10711754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00141325A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Haralson Nursing & Rehabilitation Center.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kelanie Williamson Clotfelter, ED.S
• Kimberly E Cobb, REGISTERED NURSE
• Constance Faith Cochran
• Kristina Sarahmae Coggins, PA-C
• Katie Lynn Cooper

• All providers in Bremen, GA
• Skilled Nursing Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.