Healthcare Provider Details

I. General information

NPI: 1710388699
Provider Name (Legal Business Name): SL SNF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 SIMMONS ST
DUBLIN GA
31021-3918
US

IV. Provider business mailing address

606 SIMMONS ST
DUBLIN GA
31021-3918
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-1666
  • Fax: 478-275-2146
Mailing address:
  • Phone: 478-272-1666
  • Fax: 478-275-2146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BRUCE E WERTHEIM
Title or Position: MANAGER
Credential:
Phone: 917-919-7204