Healthcare Provider Details

I. General information

NPI: 1902830961
Provider Name (Legal Business Name): THE PLACE AT POOLER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S ROGERS ST
POOLER GA
31322-3116
US

IV. Provider business mailing address

508 S ROGERS ST
POOLER GA
31322-3116
US

V. Phone/Fax

Practice location:
  • Phone: 912-748-6840
  • Fax:
Mailing address:
  • Phone: 912-748-6840
  • Fax: 912-748-5214

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: W MELISSA ODEN
Title or Position: OWNER
Credential:
Phone: 615-585-4444