MEDICARE: FIVE-T HOUSING LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	171W00000X	Contractor
3	174200000X	Meals Provider
4	177F00000X	Lodging Provider
5	172A00000X	Driver

General Provider Information

NPI Number	:	1699635292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVE-T HOUSING LLC

Provider Business Mailing Address
First Line	:	1776 N JEFFERSON ST NE
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061-2229
Country	:	US
Telephone Number	:	478-456-1036
Fax Number	:

Provider Business Practice Location Address
First Line	:	1776 N JEFFERSON ST NE
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061-2229
Country	:	US
Telephone Number	:	478-456-1036
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TABBERTINA BUNDRAGE
Credential	:
Telephone Number	:	478-456-1036

Provider Enumeration Date	:	11/15/2025
Last Update Date	:	11/15/2025

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