Southern Breeze PCH

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

SOUTHERN BREEZE PCH

Practice address

127 S Belair Rd
Martinez, GA 30907-9111

Phone

(706) 799-0308

Fax

(706) 504-4162

NPI assigned

Mar 26, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Annette M Holley

Title

Ceo

Phone

(706) 799-0308

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522022400000",
    "number": "1245735950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 S BELAIR RD",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309079111",
            "telephone_number": "706-799-0308",
            "fax_number": "706-504-4162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 S BELAIR RD",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309079111",
            "telephone_number": "706-799-0308",
            "fax_number": "706-504-4162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN BREEZE PCH",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-26",
        "last_updated": "2018-03-26",
        "status": "A",
        "authorized_official_last_name": "HOLLEY",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-799-0308",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003143758A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Martinez, GA
• Providers in Martinez, GA by specialty
• Assisted Living Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.