| Organization Name: | COVINGTON MANOR NURSING HOME LLC |
| NPI Number: | 1760688550 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RONNIE CRUMP (OWNER) |
| Mailing Address: | 440 Industrial Blvd Hawkinsville |
| State: | GA US |
| Postal Code: | 31036 |
| Phone Number: | 4787834988 |
| Fax Number: | |
| NPI Enumeration Date: | 06/27/2007 |
| NPI Last Update Date: | 01/02/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BN1400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Nursing Facility Supplies |
| Taxonomy Definition: | |