Provider Demographics
NPI:1598253684
Name:COMFORT COMMUNITY CENTER, LLC
Entity type:Organization
Organization Name:COMFORT COMMUNITY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOHIREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-581-1831
Mailing Address - Street 1:2440 SANDY PLAINS ROAD
Mailing Address - Street 2:BLVD 21, SUITE 100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066
Mailing Address - Country:US
Mailing Address - Phone:678-401-8743
Mailing Address - Fax:770-675-3347
Practice Address - Street 1:2440 SANDY PLAINS ROAD
Practice Address - Street 2:BLVD 21, SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066
Practice Address - Country:US
Practice Address - Phone:678-401-8743
Practice Address - Fax:770-675-3347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA702748549NMedicaid