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General NPI Number Information
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NPI Number | 1417639311
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Entity Type | Organization
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Legal Business Name | GIBSON HEALTH OPCO LLC
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Dates
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Enumeration Date | 08/01/2023
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 434 BEALL SPRINGS RD
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City | GIBSON
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State | GA
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Zip | 30810-4224
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Country | US
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Telephone | 706-598-3201
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Fax |
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Provider Business Mailing Address
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Address Line | 434 BEALL SPRINGS RD
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City | GIBSON
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State | GA
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Zip | 30810-4224
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Country | US
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Telephone | 706-598-3201
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Fax |
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Authorized Official
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Title or Position | MEMBER OF LLC
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Name | TRACI TODD
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Credential |
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Telephone | 478-200-0301
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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 |
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License Number State |
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