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General NPI Number Information
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NPI Number | 1023044518
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Entity Type | Organization
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Legal Business Name | BULLOCH COUNTY LTC LLC
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 405 S COLLEGE ST
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City | STATESBORO
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State | GA
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Zip | 30458-5409
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Country | US
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Telephone | 912-764-4575
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Fax | 912-764-3916
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Provider Business Mailing Address
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Address Line | PO BOX 746
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City | STATESBORO
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State | GA
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Zip | 30459-0746
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Country | US
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Telephone | 912-764-4575
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Fax | 912-764-3916
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TAYLOR MCCOY
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Credential |
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Telephone | 912-764-4575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1-016-1898
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License Number State | GA
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