Healthcare Provider Details

I. General information

NPI: 1922452986
Provider Name (Legal Business Name): FAVOR OF FAVOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 VAN NUYS BLVD
SAVANNAH GA
31419-1341
US

IV. Provider business mailing address

203 VAN NUYS BLVD
SAVANNAH GA
31419-1341
US

V. Phone/Fax

Practice location:
  • Phone: 912-228-0971
  • Fax:
Mailing address:
  • Phone: 912-228-0971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: SANDRA MAZO
Title or Position: CEO
Credential:
Phone: 912-228-0971