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General NPI Number Information
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NPI Number | 1255508081
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Entity Type | Organization
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Legal Business Name | SYLVANIA WAY INC
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 803 W OGEECHEE ST
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City | SYLVANIA
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State | GA
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Zip | 30467-8696
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Country | US
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Telephone | 912-564-2347
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Fax |
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Provider Business Mailing Address
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Address Line | 104 E TELEPHONE ST
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City | SYLVANIA
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State | GA
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Zip | 30467-1959
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Country | US
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Telephone | 912-564-2513
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Fax | 912-564-2750
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Authorized Official
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Title or Position | ACCOUNTANT
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Name | MS. CYNTHIA R GLISSON
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Credential | CPA
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Telephone | 912-564-2513
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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 | 022203095A
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License Number State | GA
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