Mt. Kenn Nursing, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1-033-1982 Issued in GA

Legal business name

MT. KENN NURSING, LLC

Doing business as

Autumn Breeze Healthcare Center

Practice address

1480 Sandtown Road
Marietta, GA 30008-3821

Phone

(770) 442-1755

Fax

(770) 442-8784

NPI assigned

May 24, 2006

Organization subpart

No

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

Authorized official

Name

Boyd P Gentry Jr.

Title

Presidnet and Ceo

Phone

(937) 964-8974

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Autumn Breeze Healthcare Center Doing business as

Locations

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311552000000",
    "number": "1053366336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5057 TROY ROAD",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455028150",
            "telephone_number": "937-964-8974",
            "fax_number": "937-964-8961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1480 SANDTOWN ROAD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300083821",
            "telephone_number": "770-442-1755",
            "fax_number": "770-442-8784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT. KENN NURSING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2011-07-25",
        "status": "A",
        "authorized_official_last_name": "GENTRY",
        "authorized_official_first_name": "BOYD",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDNET AND CEO",
        "authorized_official_telephone_number": "937-964-8974",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "05-47025",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "1-033-1982",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00140159A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Autumn Breeze Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joseph H Moyers, MD
• MRM Medical Group
• Gaspar Msangi, M.D.
• Nokuthula Nondumiso Msimanga, MD
• Mt. Bethel Shepherd Center Inc.
• Caitlin Virginia Mueller, DO
• Michael Mueller, PH.D., BCBA
• Isma Mughal, PHARMD
• Sulman Mughal, MD
• Darlene Muhammad

• Skilled Nursing Facility in Marietta, GA
• Providers in Marietta, GA by specialty
• Skilled Nursing Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2011; 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.