Healthcare Provider Details

I. General information

NPI: 1174445696
Provider Name (Legal Business Name): WASHCO GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 STANLEY ST
PERRY GA
31069-5176
US

IV. Provider business mailing address

315 HAYWOOD DR
KATHLEEN GA
31047-3117
US

V. Phone/Fax

Practice location:
  • Phone: 414-678-8573
  • Fax:
Mailing address:
  • Phone: 414-678-8573
  • 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: TONY GLEN WASHINGTON
Title or Position: OWNER
Credential:
Phone: 414-678-8573