Fayetteville Ga Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

FAYETTEVILLE GA OPCO LLC

Doing business as

Condor Health Lafayette

Practice address

110 Brandywine Blvd
Fayetteville, GA 30214-1500

Phone

(770) 461-2928

NPI assigned

Aug 14, 2019

Last updated

Aug 14, 2019By 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

Batya Gorelick

Title

VP of Admin Services

Phone

(770) 461-2928

Specialties & licenses 2

Addresses

Other names 1

• Condor Health Lafayette Doing business as

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

{
    "created_epoch": "1565740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565740800000",
    "number": "1740836832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 SYLVAN AVE STE 240",
            "city": "ENGLEWOOD CLIFFS",
            "state": "NJ",
            "postal_code": "076322700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BRANDYWINE BLVD",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141500",
            "telephone_number": "770-461-2928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE GA OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-14",
        "last_updated": "2019-08-14",
        "status": "A",
        "authorized_official_last_name": "GORELICK",
        "authorized_official_first_name": "BATYA",
        "authorized_official_title_or_position": "VP OF ADMIN SERVICES",
        "authorized_official_telephone_number": "770-461-2928"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Condor Health Lafayette",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2019; 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.