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General NPI Number Information
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NPI Number | 1770986622
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Entity Type | Organization
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Legal Business Name | THE VILLAS AT BELLEVUE, LLC
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Dates
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Enumeration Date | 10/07/2014
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 903 BELLEVUE AVE
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City | DUBLIN
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State | GA
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Zip | 31021-4849
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Country | US
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Telephone | 478-275-2015
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Fax | 478-275-2057
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Provider Business Mailing Address
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Address Line | 411 WITHERINGTON CIR
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City | EAST DUBLIN
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State | GA
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Zip | 31027-3222
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Country | US
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Telephone | 478-290-2905
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN D WALKER
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Credential |
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Telephone | 478-274-0043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | PCH008494
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License Number State | GA
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