=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609513860
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAXON PCH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2022
-----------------------------------------------------
Last Update Date | 05/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1125 PINEY GROVE RD
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30906-8714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-793-8242
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27 MOUNTAIN AVE
-----------------------------------------------------
City | COLD SPRING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10516-1804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-221-7080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | ARAHM LEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 646-221-7080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------