=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437372844
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE MADISON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 S MADISON ST
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31701-3113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-420-7971
-----------------------------------------------------
Fax | 229-420-7971
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1604 LILY POND RD
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31701-7760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-869-9584
-----------------------------------------------------
Fax | 220-429-7971
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. JANICE TEEMER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 229-430-7971
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------