Healthcare Provider Details

I. General information

NPI: 1932657616
Provider Name (Legal Business Name): JV JEFFERSONVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 SPRING VALLEY RD
JEFFERSONVILLE GA
31044-3917
US

IV. Provider business mailing address

113 SPRING VALLEY RD
JEFFERSONVILLE GA
31044-3917
US

V. Phone/Fax

Practice location:
  • Phone: 478-298-6700
  • Fax: 478-298-6400
Mailing address:
  • Phone: 478-298-6700
  • Fax: 478-298-6400

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: KAREN D FORRISTER
Title or Position: MEMBER
Credential:
Phone: 404-620-7659