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General NPI Number Information
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NPI Number | 1922452986
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Entity Type | Organization
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Legal Business Name | FAVOR OF FAVOR LLC
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Dates
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Enumeration Date | 04/15/2016
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Last Update Date | 04/15/2016
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Provider Practice Location Address
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Address Line | 203 VAN NUYS BLVD
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City | SAVANNAH
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State | GA
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Zip | 31419-1341
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Country | US
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Telephone | 912-228-0971
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Fax |
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Provider Business Mailing Address
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Address Line | 203 VAN NUYS BLVD
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City | SAVANNAH
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State | GA
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Zip | 31419-1341
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Country | US
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Telephone | 912-228-0971
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SANDRA MAZO
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Credential |
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Telephone | 912-228-0971
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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 |
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License Number State |
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