Healthcare Provider Details

I. General information

NPI: 1487509485
Provider Name (Legal Business Name): SEACOAST AT GOVERNOR'S GLEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 GOVERNORS DR
FOREST PARK GA
30297-6138
US

IV. Provider business mailing address

5000 GOVERNORS DR
FOREST PARK GA
30297-6138
US

V. Phone/Fax

Practice location:
  • Phone: 404-362-0404
  • Fax:
Mailing address:
  • Phone: 404-362-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN NADEAU
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 954-261-2650