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General NPI Number Information
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NPI Number | 1487648010
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Entity Type | Organization
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Legal Business Name | GLASCOCK COUNTY HEALTH CARE LLC
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 05/24/2011
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Provider Practice Location Address
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Address Line | 434 BEALL SPRINGS RD
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City | GIBSON
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State | GA
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Zip | 30810-4224
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Country | US
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Telephone | 706-598-2167
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Fax | 706-598-3802
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Provider Business Mailing Address
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Address Line | PO BOX 248
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City | GIBSON
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State | GA
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Zip | 30810-0248
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Country | US
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Telephone | 706-598-2167
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Fax | 706-598-3802
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JIMMIE STEWART
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Credential |
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Telephone | 706-598-2167
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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 | 062-02-001-1
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License Number State | GA
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