Healthcare Provider Details

I. General information

NPI: 1356698005
Provider Name (Legal Business Name): MADISON AT THE VALENCIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 SOUTH VALENCIA DRIVE
ALBANY GA
31707
US

IV. Provider business mailing address

605 SOUTH VALENCIA DRIVE
ALBANY GA
31707
US

V. Phone/Fax

Practice location:
  • Phone: 229-420-7971
  • Fax: 229-420-7971
Mailing address:
  • Phone: 229-420-7971
  • Fax: 229-420-7971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. JANICE TEEMER
Title or Position: ADMINISTRATOR / CEO
Credential:
Phone: 229-420-7971