MEDICARE: JBC ASSISTED LIVING GROUP HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1184757205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JBC ASSISTED LIVING GROUP HOME

Provider Business Mailing Address
First Line	:	235 BIG SIX FARMS RD
Second Line	:
City	:	FORT VALLEY
State	:	GA
Zip	:	31030-8528
Country	:	US
Telephone Number	:	478-825-8511
Fax Number	:	478-825-3757

Provider Business Practice Location Address
First Line	:	235 BIG SIX FARMS RD
Second Line	:
City	:	FORT VALLEY
State	:	GA
Zip	:	31030-8528
Country	:	US
Telephone Number	:	478-825-8511
Fax Number	:	478-825-3757

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JACQUELYN TERRELL CARTWRIGHT
Credential	:
Telephone Number	:	478-825-8511

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	08/22/2020

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