Healthcare Provider Details

I. General information

NPI: 1932992567
Provider Name (Legal Business Name): COTTAGE GROVE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3872 SUWANEE MILL DR
BUFORD GA
30518-8786
US

IV. Provider business mailing address

3872 SUWANEE MILL DR
BUFORD GA
30518-8786
US

V. Phone/Fax

Practice location:
  • Phone: 404-808-3983
  • Fax:
Mailing address:
  • Phone: 404-808-3983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. RUTH ASHLEY MAXINE BURGESS
Title or Position: CEO / DIRECTOR OF NURSING
Credential: RN
Phone: 404-808-3983