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General NPI Number Information
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NPI Number | 1912210501
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Entity Type | Organization
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Legal Business Name | HILL'S HOUSE
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Dates
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Enumeration Date | 07/23/2010
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Last Update Date | 10/11/2010
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Provider Practice Location Address
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Address Line | 3649 HIGHWAY 88
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City | BLYTHE
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State | GA
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Zip | 30805-3620
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Country | US
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Telephone | 706-751-0043
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Fax | 706-733-9853
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Provider Business Mailing Address
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Address Line | PO BOX 62 3649 HWY 88
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City | BLYTHE
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State | GA
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Zip | 30805-0062
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Country | US
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Telephone | 706-751-0043
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Fax | 706-733-9853
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. QUANTRELL CHARLES HANNAH II
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Credential |
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Telephone | 706-871-8119
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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 | 121-02-072-9
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License Number State | GA
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