Healthcare Provider Details

I. General information

NPI: 1629458963
Provider Name (Legal Business Name): SUMMERS RETIREMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S KIMBERLY RD
WARNER ROBINS GA
31088-8721
US

IV. Provider business mailing address

200 S KIMBERLY RD
WARNER ROBINS GA
31088-8721
US

V. Phone/Fax

Practice location:
  • Phone: 478-293-4900
  • Fax: 478-293-4892
Mailing address:
  • Phone: 478-293-4900
  • Fax: 478-293-4892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-076-2068
License Number StateGA

VIII. Authorized Official

Name: DEBORAH L MEADE
Title or Position: MEMBER
Credential:
Phone: 478-328-3800