Adk Jeffersonville Operator, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

11431882 Issued in GA

Legal business name

ADK JEFFERSONVILLE OPERATOR, LLC

Practice address

113 Spring Valley Drive
Jeffersonville, GA 31044-9301

Phone

(478) 945-2520

Fax

(478) 945-2525

NPI assigned

Jan 16, 2007

Organization subpart

No

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

Authorized official

Name

Carol Groeber

Title

VP Mis

Phone

(937) 964-8974

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jeffersonville Nursing & Rehab Center Doing business as

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294790400000",
    "number": "1053463786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 SPRING VALLEY DRIVE",
            "city": "JEFFERSONVILLE",
            "state": "GA",
            "postal_code": "310449301",
            "telephone_number": "478-945-2520",
            "fax_number": "478-945-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 SPRING VALLEY DRIVE",
            "city": "JEFFERSONVILLE",
            "state": "GA",
            "postal_code": "310449301",
            "telephone_number": "478-945-2520",
            "fax_number": "478-945-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADK JEFFERSONVILLE OPERATOR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2011-01-12",
        "status": "A",
        "authorized_official_last_name": "GROEBER",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "VP MIS",
        "authorized_official_telephone_number": "937-964-8974"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "11431882",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00282235A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jeffersonville Nursing & Rehab Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Altaevist Basley
• Ashley Elaine Boatright, RN
• Christopher Jerry Brown, DNP, FNP-BC
• Community Health Care Systems Inc,
• Community Health Care Systems, Inc.

• Skilled Nursing Facility in Jeffersonville, GA
• Providers in Jeffersonville, 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 Jan 12, 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.