1932789781 NPI number — SOUTHERN PINES RETIREMENT VILLA

Table of content: (NPI 1932789781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932789781 NPI number — SOUTHERN PINES RETIREMENT VILLA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN PINES RETIREMENT VILLA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932789781
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
345 PERRY HWY.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAWKINSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-783-3445
Provider Business Mailing Address Fax Number:
478-783-3545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 PERRY HWY.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAWKINSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-783-3445
Provider Business Practice Location Address Fax Number:
478-783-3545
Provider Enumeration Date:
04/14/2021

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDSON
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
478-279-3286

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 311Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 116-01-001-1 . This is a "PERSONAL CARE HOME PERM." identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com