=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003179979
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUNT HOLDINGS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2012
-----------------------------------------------------
Last Update Date | 06/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2822 KNOB HILL FARM RD
-----------------------------------------------------
City | EVANS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30809-6618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-860-0541
-----------------------------------------------------
Fax | 706-860-0315
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2822 KNOB HILL FARM RD
-----------------------------------------------------
City | EVANS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30809-6618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-860-0541
-----------------------------------------------------
Fax | 706-860-0315
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO, ADMINISTRATOR
-----------------------------------------------------
Name | MR. RYAN LEE HUNT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 706-860-0541
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------