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General NPI Number Information
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NPI Number | 1437513116
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Entity Type | Organization
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Legal Business Name | MARSHALL RETIREMENT CENTER
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 04/08/2016
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Provider Practice Location Address
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Address Line | 619 ALLEN AVENUE
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City | BLACKSHEAR
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State | GA
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Zip | 31516
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Country | US
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Telephone | 912-449-1380
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Fax | 912-449-1380
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Provider Business Mailing Address
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Address Line | P.O.B. 650
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City | BLACKSHEAR
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State | GA
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Zip | 31516
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Country | US
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Telephone | 912-449-1380
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Fax | 912-449-1380
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MRS. DOLLIE BOGGS MARSHALL
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Credential | OWNER
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Telephone | 912-449-1380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | GA
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Taxonomy #2
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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 | GA
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