Provider Demographics
NPI:1174519326
Name:ATLANTA ASSOCIATION FOR CONVALESCENT AGED PERSONS, INC.
Entity type:Organization
Organization Name:ATLANTA ASSOCIATION FOR CONVALESCENT AGED PERSONS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT /CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAXTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:678-420-2904
Mailing Address - Street 1:1821 ANDERSON AVE NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314-1835
Mailing Address - Country:US
Mailing Address - Phone:404-794-2477
Mailing Address - Fax:404-799-9876
Practice Address - Street 1:1821 ANDERSON AVE NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-1835
Practice Address - Country:US
Practice Address - Phone:404-794-2477
Practice Address - Fax:404-799-9876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00141842AMedicaid
GA0871320001Medicare NSC
GA00141842AMedicaid