Healthcare Provider Details

I. General information

NPI: 1851347157
Provider Name (Legal Business Name): SAVANNAH RESIDENTIAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 FLORENCE RD
SAVANNAH TN
38372-3402
US

IV. Provider business mailing address

1400 FLORENCE RD
SAVANNAH TN
38372-3402
US

V. Phone/Fax

Practice location:
  • Phone: 731-926-4044
  • Fax:
Mailing address:
  • Phone: 731-926-4044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JAMES REIKER
Title or Position: TREASURER
Credential:
Phone: 573-471-1113