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General NPI Number Information
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NPI Number | 1417851130
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Entity Type | Organization
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Legal Business Name | SUMMER WILLOW, LLC
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 259 NUNEZ LEXSY RD
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City | SWAINSBORO
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State | GA
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Zip | 30401-5170
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Country | US
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Telephone | 912-562-4325
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1314
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City | SWAINSBORO
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State | GA
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Zip | 30401-1314
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Country | US
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Telephone | 912-562-4325
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SOPHIE VAUTIER
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Credential |
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Telephone | 478-206-5165
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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 | NULL
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