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General NPI Number Information
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NPI Number | 1427369966
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Entity Type | Organization
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Legal Business Name | TENNILLE RETIREMENT HOME, LLC
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 525 N MAIN ST
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City | TENNILLE
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State | GA
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Zip | 31089-1128
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Country | US
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Telephone | 478-862-9051
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2028
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City | BUTLER
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State | GA
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Zip | 31006-2028
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Country | US
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Telephone | 478-862-9051
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JAMASON BYRD
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Credential |
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Telephone | 478-862-9051
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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 | 150-03-001-1
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License Number State | GA
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