Provider Demographics
NPI:1174909840
Name:460 AUBURN AVENUE, L.P.
Entity type:Organization
Organization Name:460 AUBURN AVENUE, L.P.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-282-4755
Mailing Address - Street 1:3000 OLD ALABAMA RD STE 119-403
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5860
Mailing Address - Country:US
Mailing Address - Phone:404-282-4755
Mailing Address - Fax:404-681-4536
Practice Address - Street 1:460 AUBURN AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1504
Practice Address - Country:US
Practice Address - Phone:404-523-1613
Practice Address - Fax:404-681-4536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility