Cplace Decatur SNF LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1-044-1435 Issued in GA

Legal business name

CPLACE DECATUR SNF LLC

Doing business as

East Lake Arbor

Practice address

304 Fifth Ave
Decatur, GA 30030-4812

Phone

(404) 373-6231

NPI assigned

Mar 23, 2017

Last updated

Mar 23, 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

• East Lake Arbor Doing business as

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

{
    "created_epoch": "1490227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490227200000",
    "number": "1265963144",
    "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": "304 FIFTH AVE",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300304812",
            "telephone_number": "404-373-6231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CPLACE DECATUR SNF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-23",
        "last_updated": "2017-03-23",
        "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": "1-044-1435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Lake Arbor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Steve M Covington III, M.D.
• Deborah Cox, CNA
• Nycole Ashley Cox, FNP-C, PMHNP-BC
• Stephanie Nicole Cox
• Bernard Coxton Jr., PA-C
• Shania Michelle Craig
• Annalee Craigmile, LMSW
• Carrie Ann Crain, M.S.
• Ericka M. Crane, PT
• Jimiesh G Crane, DDS

• Skilled Nursing Facility in Decatur, GA
• Providers in Decatur, 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 23, 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.