NPI 1558589168

Stone Mountain

Organisation Assisted Living Facility Stone Mountain, GA

Practice location

Address: 1745 Parke Plaza Cir, Stone Mountain, GA 30087-3498
Phone: (770) 469-8800
Fax: (503) 485-1279
Mailing address: PO Box 3006, Salem, OR 97302-0006

Authorised official

Name: Jon Harder
Title: Ceo President
Phone: (503) 485-8697

Registered specialties

Assisted Living Facility Primary

Nursing & Custodial Care Facilities Taxonomy 310400000X

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Registry record

NPI: 1558589168
Entity type: Organization
NPI issued: 22 Apr 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.