- Enrollment id
- O20030722000001
- Enrollment state
- GA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1760483606
- Multiple npi flag
- N
- Ccn
- 115319
- Associate id
- 1456262336
- Organization name
- NORTH GEORGIA CARE SERVICES INC
- Doing business as name
- FIFTH AVENUE HEALTH CARE
- Incorporation date
- 2003-03-11
- Incorporation state
- GA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- FIFTH AVENUE HEALTH CARE
- Affiliation entity name
- RELIABLE HEALTH CARE MANAGEMENT
- Affiliation entity id
- 728
- Address line 1
- 505 N 5TH AVE SW
- City
- ROME
- State
- GA
- Zip code
- 301652822