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General NPI Number Information
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NPI Number | 1457630311
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Entity Type | Organization
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Legal Business Name | DOGWOOD BLUFF PERSONAL CARE HOME
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 266 PONY LAKE LN
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City | DAHLONEGA
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State | GA
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Zip | 30533-6309
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Country | US
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Telephone | 706-974-7704
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Fax | 770-536-0776
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Provider Business Mailing Address
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Address Line | 266 PONY LAKE LN
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City | DAHLONEGA
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State | GA
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Zip | 30533-6309
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Country | US
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Telephone | 706-974-7704
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Fax | 770-536-0776
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. CAROLYN JOYCE BURGESS
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Credential |
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Telephone | 706-974-7704
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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 |
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