CHC-Pine Knoll Nursing & Rehab Ctr, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

10221757 Issued in GA

Legal business name

CHC-PINE KNOLL NURSING & REHAB CTR, LLC

Practice address

156 Pine Knoll Dr
Carrollton, GA 30117-2451

Phone

(770) 832-8243

Fax

(770) 832-8221

NPI assigned

Jun 23, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Alex Paley

Title

Coo

Phone

(914) 390-4363

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pine Knoll Nursing & Rehabiliation Center Doing business as

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395360000000",
    "number": "1255337341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "156 PINE KNOLL DR",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301172451",
            "telephone_number": "770-832-8243",
            "fax_number": "770-832-8221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 PINE KNOLL DR",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301172451",
            "telephone_number": "770-832-8243",
            "fax_number": "770-832-8221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHC-PINE KNOLL NURSING & REHAB CTR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-23",
        "last_updated": "2014-03-21",
        "status": "A",
        "authorized_official_last_name": "PALEY",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "914-390-4363",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "10221757",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00142458A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Knoll Nursing & Rehabiliation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Carrollton, GA
• Providers in Carrollton, 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, 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.