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General NPI Number Information
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NPI Number | 1790945202
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Entity Type | Organization
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Legal Business Name | PLACE AT AUGUSTA LLC
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 820 STEVENS CREEK RD
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City | AUGUSTA
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State | GA
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Zip | 30907-9251
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Country | US
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Telephone | 706-860-6622
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Fax |
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Provider Business Mailing Address
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Address Line | 820 STEVENS CREEK RD
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City | AUGUSTA
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State | GA
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Zip | 30907-9251
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Country | US
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Telephone | 706-860-6622
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Fax |
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Authorized Official
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Title or Position | REIMBURSEMENT MANAGER
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Name | SUSAN R MCGUIRE
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Credential | CPA
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Telephone | 404-641-1919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 11211847
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License Number State | GA
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