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General NPI Number Information
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NPI Number | 1285251926
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Entity Type | Organization
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Legal Business Name | NINA'S HAVEN PERSONAL CARE HOME
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Dates
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Enumeration Date | 06/29/2020
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 306 W MANN ST
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City | GLENNVILLE
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State | GA
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Zip | 30427-2040
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Country | US
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Telephone | 912-654-1649
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Fax |
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Provider Business Mailing Address
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Address Line | 306 W MANN ST
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City | GLENNVILLE
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State | GA
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Zip | 30427-2040
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Country | US
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Telephone | 912-654-1649
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MR. ANTHONY GAYLE
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Credential |
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Telephone | 786-370-4781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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