Georgia Tucker LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

GEORGIA TUCKER LLC

Doing business as

The Gardens at Georgia Tucker

Practice address

405 Stubbs Ave
Monroe, LA 71201-5505

Phone

(318) 538-0040

NPI assigned

Apr 12, 2021

Last updated

Apr 12, 2021By 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

Kyle Coburn

Title

Coo

Phone

(318) 789-2001

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Gardens at Georgia Tucker Doing business as

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1618185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618185600000",
    "number": "1831779107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 PINE ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712016228",
            "telephone_number": "318-699-8819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 STUBBS AVE",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712015505",
            "telephone_number": "318-538-0040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA TUCKER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-12",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-12",
        "status": "A",
        "authorized_official_last_name": "COBURN",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "318-789-2001"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1709581",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.georgiatucker.com",
            "affiliation": "N",
            "endpointDescription": "web address",
            "address_1": "405 Stubbs Ave",
            "city": "Monroe",
            "state": "LA",
            "country_code": "US",
            "postal_code": "712015505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "The Gardens at Georgia Tucker",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Monroe, LA
• Providers in Monroe, LA by specialty
• Assisted Living Facility in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2021; 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.