NPIMap

Organization Active NPI

PMR Georgia Holding, LLC

Doing business as Jencare Senior Medical Center Belvedere

  • Non-Pharmacy Dispensing Site
  • Decatur, GA
National Provider Identifier
1508646779
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
PMR GEORGIA HOLDING, LLC
Doing business as
Jencare Senior Medical Center Belvedere
Practice address
3805 Covington Hwy
Decatur, GA 30032-2643
Phone
(404) 383-1300
Fax
(404) 383-0772
NPI assigned
Oct 4, 2023
Last updated
Oct 4, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
PMR GEORGIA HOLDING, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Authorized official

Name
Mary Chen
Title
Authorized Official
Phone
(305) 628-6117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X NU Primary

Addresses

Primary practice location

3805 Covington Hwy
Decatur, GA 30032-2643

Mailing address

1395 NW 167TH St
Miami Gardens, FL 33169-5710
Phone (305) 628-6117

Other names 1

  • JENCARE SENIOR MEDICAL CENTER BELVEDERE Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2292992Jencare Senior Medical Center- Belvedere3805 Covington Highway, Decatur, GA 30032Certificate of waiverNov 1, 2027

National Provider Directory

National Provider Directory
Tax ID family
PMR Georgia Holding LLC4 organizations share this tax ID, including this one
Part of
PMR Georgia Holding LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3805 Covington Hwy
Decatur, GA 30032
Phone (404) 383-1300

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1696377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1508646779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695710",
            "telephone_number": "305-628-6117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3805 COVINGTON HWY",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300322643",
            "telephone_number": "404-383-1300",
            "fax_number": "404-383-0772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PMR GEORGIA HOLDING, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PMR GEORGIA HOLDING, LLC",
        "enumeration_date": "2023-10-04",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "CHEN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "305-628-6117"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JENCARE SENIOR MEDICAL CENTER BELVEDERE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.