- Enrollment id
- O20160419002562
- Enrollment state
- GA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1174909840
- Multiple npi flag
- N
- Ccn
- 115585
- Associate id
- 1153629480
- Organization name
- 460 AUBURN AVENUE LP
- Doing business as name
- LEGACY TRANSITIONAL CARE AND REHABILITATION
- Incorporation date
- 2015-06-01
- Incorporation state
- GA
- Organization type structure
- OTHER
- Organization other type text
- LIMITED PARTNERSHIP
- Proprietary nonprofit
- P
- Nursing home provider name
- LEGACY TRANSITIONAL CARE & REHABILITATION
- Affiliation entity name
- WELLINGTON HEALTH CARE SERVICES
- Affiliation entity id
- 559
- Address line 1
- 460 AUBURN AVE NE
- City
- ATLANTA
- State
- GA
- Zip code
- 303121504