Healthcare Provider Details

I. General information

NPI: 1518040351
Provider Name (Legal Business Name): ADK SAVANNAH BEACH OPERATOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 VAN HORN
TYBEE ISLAND GA
31328-9726
US

IV. Provider business mailing address

PO BOX 2509
TYBEE ISLAND GA
31328-2509
US

V. Phone/Fax

Practice location:
  • Phone: 912-786-4511
  • Fax: 912-786-7414
Mailing address:
  • Phone: 912-786-4511
  • Fax: 912-786-7414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-0251697
License Number StateGA

VIII. Authorized Official

Name: CAROL GROEBER
Title or Position: VICE PRESIDENT/MIS
Credential:
Phone: 937-964-8974