Healthcare Provider Details

I. General information

NPI: 1427017920
Provider Name (Legal Business Name): THE PLACE AT POOLER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S ROGERS STREET
POOLER GA
31322
US

IV. Provider business mailing address

508 S ROGERS STREET
POOLER GA
31322
US

V. Phone/Fax

Practice location:
  • Phone: 912-748-6840
  • Fax: 912-748-5418
Mailing address:
  • Phone: 912-748-6840
  • Fax: 912-748-5418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. KIMNIE CHAN BENNETT
Title or Position: NURSING HOME ADMINISTRATOR
Credential: NHA
Phone: 912-748-6840