| Organization Name: | MONTEZUMA HEALTH CARE CENTER LLC |
| NPI Number: | 1366464976 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JACKIE CRISP (ADMINISTRATOR) |
| Mailing Address: | 506 Sumter St Montezuma |
| State: | GA US |
| Postal Code: | 310631734 |
| Phone Number: | 4784728168 |
| Fax Number: | 4784722373 |
| NPI Enumeration Date: | 07/24/2006 |
| NPI Last Update Date: | 06/24/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | 1-094-1731 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |