Tennille Retirement Home, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

150-03-001-1 Issued in GA

Legal business name

TENNILLE RETIREMENT HOME, LLC

Practice address

525 N Main St
Tennille, GA 31089-1128

Phone

(478) 862-9051

NPI assigned

Jun 30, 2010

Last updated

Jun 30, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jamason Byrd

Title

Vice President

Phone

(478) 862-9051

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1277856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277856000000",
    "number": "1427369966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2028",
            "city": "BUTLER",
            "state": "GA",
            "postal_code": "310062028",
            "telephone_number": "478-862-9051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 N MAIN ST",
            "city": "TENNILLE",
            "state": "GA",
            "postal_code": "310891128",
            "telephone_number": "478-862-9051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TENNILLE RETIREMENT HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-30",
        "last_updated": "2010-06-30",
        "status": "A",
        "authorized_official_last_name": "BYRD",
        "authorized_official_first_name": "JAMASON",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "478-862-9051"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "GA",
            "license": "150-03-001-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115769937A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Temeka Reese, LMSW
• Linda Faye Scott, CNA
• Imani Simmons
• Amy Therese Solen
• Wende Sumner

• Assisted Living Facility in Tennille, GA
• Providers in Tennille, 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 Jun 30, 2010; 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.