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General NPI Number Information
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NPI Number | 1053024174
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Entity Type | Organization
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Legal Business Name | WATKINSVILLE OPCO LLC
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Dates
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Enumeration Date | 01/04/2023
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 2040 RESURGENCE DR
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City | WATKINSVILLE
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State | GA
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Zip | 30677-7219
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Country | US
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Telephone | 706-521-0550
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2568
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City | HICKORY
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State | NC
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Zip | 28603-2568
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Country | US
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Telephone | 828-322-5535
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. CHARLES E TREFZGER JR.
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Credential |
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Telephone | 828-322-5535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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