Quencie'S Manor LLC

Primary specialty

Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X

License

PCH009157 Issued in GA

Legal business name

QUENCIE'S MANOR LLC

Practice address

2104 Jeffersonville Rd
Macon, GA 31217-4517

Phone

(478) 832-5479

Fax

(478) 239-5148

NPI assigned

May 7, 2017

Organization subpart

No

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

Authorized official

Name

Joseph Andrews

Title

Administator

Phone

(478) 832-5479

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1494115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494115200000",
    "number": "1619403805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 JEFFERSONVILLE RD",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312174517",
            "telephone_number": "478-832-5479",
            "fax_number": "478-239-5148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 JEFFERSONVILLE RD",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312174517",
            "telephone_number": "478-832-5479",
            "fax_number": "478-239-5148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUENCIE'S MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-07",
        "last_updated": "2017-05-07",
        "status": "A",
        "authorized_official_last_name": "ANDREWS",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "ADMINISTATOR",
        "authorized_official_telephone_number": "478-832-5479"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "GA",
            "license": "PCH009157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2017; 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.