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Organization

PRIME HEALTHCARE FOUNDATION - SOUTHERN REGIONAL, LLC

Active
Parent organization
PRIME HEALTHCARE FOUNDATION - SOUTHERN REGIONAL, LLC
Organization subpart
Yes

Provider details

NPI number
Legal business name
PRIME HEALTHCARE FOUNDATION - SOUTHERN REGIONAL, LLC
Authorized official
CHRISTOPHER DOAN (CHIEF COMPLIANCE COUNSEL)
(909) 235-4307
Entity
Organization

Contact information

Practice address
11 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274-2615
(770) 991-8000
Mailing address
11 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274-2615
(770) 991-8000

Taxonomy

Speciality
Code
Description
License number
State
273Y00000X
Rehabilitation Hospital Unit
Primary
GA

Other

Enumeration date
11/12/2015
Last updated
11/12/2015
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