Provider Demographics
NPI:1053787663
Name:FC MIDLANDS KATHWOOD, LLC
Entity type:Organization
Organization Name:FC MIDLANDS KATHWOOD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-754-9660
Mailing Address - Street 1:3500 LENOX ROAD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326
Mailing Address - Country:US
Mailing Address - Phone:770-754-9660
Mailing Address - Fax:
Practice Address - Street 1:4520 TRENHOLM RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-4425
Practice Address - Country:US
Practice Address - Phone:803-787-1234
Practice Address - Fax:803-787-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility