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WILKINSON GEORGIA IDAHO SENIOR HOUSING LLC NPI 1700079829


NPI Information

NPI: 1700079829
Provider Name: WILKINSON GEORGIA IDAHO SENIOR HOUSING LLC

Other Name: WATERFORD GARDENS

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 38D2081081

Address:
4484 N SHALLOWFORD RD
DUNWOODY, GA
ZIP 30338
Phone: (770) 350-2393
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WILKINSON GEORGIA IDAHO SENIOR HOUSING LLC is an assisted living facility in Dunwoody, 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. WILKINSON GEORGIA IDAHO SENIOR HOUSING LLC NPI is 1700079829. The provider is registered as an organization entity type.
The provider Other Name Is Waterford Gardens.

The provider's business location address is:

4484 N SHALLOWFORD RD
DUNWOODY, GA
ZIP 30338-402
Phone: (770) 350-2393

The provider's authorized official is John Holtz .
The authorized official title is Controller and has the following contact phone number (541) 747-3373.

The CLIA number assigned to this NPI record is 38D2081081 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/22/2007 and was last updated on 6/19/2008.


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
1310400000XAssisted Living FacilityYes

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

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