Provider Demographics
NPI:1124678651
Name:AIRPORT ROAD REALTY LLC
Entity type:Organization
Organization Name:AIRPORT ROAD REALTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHLOMO
Authorized Official - Middle Name:
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-737-0111
Mailing Address - Street 1:415 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4834
Mailing Address - Country:US
Mailing Address - Phone:770-227-8636
Mailing Address - Fax:770-227-1450
Practice Address - Street 1:415 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4834
Practice Address - Country:US
Practice Address - Phone:770-227-8636
Practice Address - Fax:770-227-1450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility