Organization Name: | MONTEZUMA HEALTH CARE CENTER LLC |
NPI Number: | 1982628491 |
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: | 07/27/2006 |
NPI Last Update Date: | 06/24/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA0600X |
License Number: | 1-094-1731 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Adult Day Care |
Taxonomy Definition: |