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General NPI Number Information
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NPI Number | 1700167574
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Entity Type | Organization
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Legal Business Name | MOLENA EXTENDED CARE, LLC
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 185 HILL ST
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City | MOLENA
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State | GA
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Zip | 30258-3115
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Country | US
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Telephone | 770-884-5138
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Fax | 770-884-5484
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Provider Business Mailing Address
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Address Line | 185 HILL ST
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City | MOLENA
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State | GA
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Zip | 30258-3115
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Country | US
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Telephone | 770-884-5138
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Fax | 770-884-5484
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Authorized Official
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Title or Position | MANAGER
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Name | LOUISA D WINGET
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Credential |
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Telephone | 478-974-0006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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