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General NPI Number Information
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NPI Number | 1902716145
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Entity Type | Organization
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Legal Business Name | GROWTH BRIDGE SPARKS PCH LLC
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Dates
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Enumeration Date | 09/10/2026
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 204 S GOODMAN ST
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City | SPARKS
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State | GA
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Zip | 31647-7549
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Country | US
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Telephone | 229-234-9775
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Fax |
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Provider Business Mailing Address
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Address Line | 3116 HOLLY MILL RUN
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City | MARIETTA
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State | GA
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Zip | 30062-5460
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Country | US
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Telephone | 770-609-7610
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LESLIE OFORI
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Credential | MD
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Telephone | 770-568-3923
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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 |
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License Number State |
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