Basic Information
| Provider Information | |||||||||
| NPI: | 1124226964 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BHGA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2979 PGA BLVD | ||||||||
| Address2: | |||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334102911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616270664 | ||||||||
| FaxNumber: | 5616272867 | ||||||||
| Practice Location | |||||||||
| Address1: | 54 PEACHTREE PARK DR NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043516041 | ||||||||
| FaxNumber: | 4043551092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WALCZAK | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5616270664 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1-059-1719 | GA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.