Provider Demographics
NPI:1154369635
Name:THE WILLIAM BREMAN JEWISH HOME, INC.
Entity type:Organization
Organization Name:THE WILLIAM BREMAN JEWISH HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO-COO
Authorized Official - Prefix:MS
Authorized Official - First Name:NEELAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHATEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-351-1934
Mailing Address - Street 1:3150 HOWELL MILL RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2108
Mailing Address - Country:US
Mailing Address - Phone:404-351-2324
Mailing Address - Fax:404-351-6698
Practice Address - Street 1:3150 HOWELL MILL RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2108
Practice Address - Country:US
Practice Address - Phone:404-351-2324
Practice Address - Fax:404-351-6698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00040752AMedicaid
GA00040752AMedicaid