TENNILLE RETIREMENT HOME LLC NPI 1427369966

NPI Information

NPI: 1427369966
Provider Name: TENNILLE RETIREMENT HOME, LLC
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 11D0977037

Address:
525 N MAIN ST
TENNILLE, GA
ZIP 31089
Phone: (478) 862-9051
Get Directions

TENNILLE RETIREMENT HOME, LLC is an assisted living facility in Tennille, GA. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. TENNILLE RETIREMENT HOME, LLC NPI is 1427369966. The provider is registered as an organization entity type.

The provider's business location address is:

525 N MAIN ST
TENNILLE, GA
ZIP 31089-128
Phone: (478) 862-9051

The provider's authorized official is Jamason Byrd .
The authorized official title is Vice President and has the following contact phone number (478) 862-9051.

The CLIA number assigned to this NPI record is 11D0977037 - rural health clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 6/30/2010 and was last updated on 6/30/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility		150-03-001-1	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	115769937A	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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