11D0696387 CLIA NUMBER - ATLANTA GA OPCO

Laboratory Demographics

CLIA Number: 11D0696387

Facility Name: ATLANTA GA OPCO

Facility Address:
54 PEACHTREE PARK DRIVE NE
ATLANTA, GA
ZIP 30309
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Facility Phone Number: 404 351-6041

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver

NPI Number: 1164141677

Taxonomy: 314000000X - Skilled Nursing Facility
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

CLIA Record

Field Name	Field Value
CLIA Number	11D0696387
LAB Type	Skilled Nursing Facility/Nursing Facility
Facility Name	ATLANTA GA OPCO
Street	54 PEACHTREE PARK DRIVE NE
City	ATLANTA
State	GA
ZIP	30309
Phone	404 351-6041
CertificateType	4
CertificateEffectiveDate	12/14/2023
CertificateExpirationDate	12/13/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024