Glascock County Health Care LLC
Organization Active NPI Assisted Living Facility · Gibson, GA
NPI 1487648010 · NPPES record last updated May 24, 2011
Key facts
- NPI
- 1487648010
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Assisted Living Facility 310400000X
- License
- 062-02-001-1 (GA)
- Legal business name
- GLASCOCK COUNTY HEALTH CARE LLC
- Practice address
- 434 Beall Springs Rd
Gibson, GA 30810-4224 - Phone
- (706) 598-2167
- Fax
- (706) 598-3802
- NPI assigned
- Sep 9, 2005
- Organization subpart
- No
Authorized official
- Name
- Jimmie Stewart
- Title
- Administrator
- Phone
- (706) 598-2167
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 062-02-001-1 | GA | Yes |
Addresses
Primary practice location
434 Beall Springs Rd
Gibson, GA 30810-4224
Mailing address
PO Box 248
Gibson, GA 30810-0248
Phone (706) 598-2167
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000258706A | Medicaid | GA |
Other names
- The Southern Living Center
Other providers in Gibson, GA
- Doriann Dye
- Gibson Health Opco LLC
- Glascock County Board of Health
- Glascock County Board of Health
- Glascock County Boe
- Glascock County Health Care LLC
- Nona Joe Lord
- Holly Lynn Stewart
- Debbie B Williford
All providers in Gibson, GA · Assisted Living Facility in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 24, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.