Cplace Jasper SNF LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1-112-1479 Issued in GA

Legal business name

CPLACE JASPER SNF LLC

Doing business as

Grandview Heath Care Center

Practice address

618 Gennett Dr
Jasper, GA 30143-1143

Phone

(706) 692-5123

NPI assigned

Mar 21, 2017

Last updated

Mar 21, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Victor M Marcos

Title

Cfo

Phone

(917) 209-1431

Specialties & licenses 1

Addresses

Other names 1

• Grandview Heath Care Center Doing business as

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

{
    "created_epoch": "1490054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490054400000",
    "number": "1083145114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24641 US HIGHWAY 19 N",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337635007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 GENNETT DR",
            "city": "JASPER",
            "state": "GA",
            "postal_code": "301431143",
            "telephone_number": "706-692-5123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CPLACE JASPER SNF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-21",
        "last_updated": "2017-03-21",
        "status": "A",
        "authorized_official_last_name": "MARCOS",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "917-209-1431"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "1-112-1479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grandview Heath Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Leslie G Cornelison, RPH
• Kristen Elizabeth Cornelius, MSN, AG-ACNP, CV-BC
• Wanda Denise Correia, F.N.P.
• Coster Care (Ball Ground Family Practice,P.C.)
• Charles Leo Coster, D.O
• Laura Craig
• Crescent Services LLC (Jasper Drug Store)
• Crescent Services LLC (Jasper Drug Store)
• Nicholas B Cummings, PHARMD
• Emily S Cummins, NP-C

• Skilled Nursing Facility in Jasper, GA
• Providers in Jasper, 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 Mar 21, 2017; 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.