Organization
SHADY GROVE REST HOME INC
Active
Other names
Ross Memorial Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES W ROSS JR. (ADMINISTRATOR)
(770) 427-7256
Entity
Organization
Contact information
Practice address
1780 OLD 41 HWY NW, KENNESAW, GA 30152-4428
(770) 427-7256
(770) 514-6831
Mailing address
1780 OLD 41 HWY NW, KENNESAW, GA 30152-4428
(770) 427-7256
(770) 514-6831
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
10331268
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00142942A
—
GA
01
—
4645261
AETNA INSURANCE CO
GA
01
—
7100156
EVERCARE UNITED HEALTHCAR
GA
Enumeration date
12/06/2006
Last updated
08/22/2020
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