Cplace Fairburn SNF LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1-060-1010 Issued in GA

Legal business name

CPLACE FAIRBURN SNF LLC

Practice address

178 W Campbellton St
Fairburn, GA 30213-1219

Phone

(770) 964-1320

NPI assigned

Mar 23, 2017

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

• Fairburn Health Care Center 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": "1861923740",
    "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": "178 W CAMPBELLTON ST",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302131219",
            "telephone_number": "770-964-1320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CPLACE FAIRBURN 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": "1-060-1010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairburn Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Fairburn, GA
• 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.