Provident Group - Creekside Properties LLC
Assisted Living Facility in Smyrna, GA. Organization (NPI-2).
NPI number1891287645
StatusActive
Last updated in NPPESJun 6, 2018
Details
- NPI
- 1891287645
- Entity type
- Organization (NPI-2)
- Legal business name
- Provident Group - Creekside Properties LLC
- Organization subpart
- No
- Enumeration date
- Jun 6, 2018
- Last updated
- Jun 6, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 310400000X | Assisted Living Facility | – | – | Yes |
| 311500000X | Alzheimer Center (Dementia Center) | – | – | |
| 385H00000X | Respite Care | – | – |
Other names
- Provident Village At Creekside (Doing Business As)
Practice location
4838 South Cobb DriveSmyrna, GA 30080
Phone 678-710-1834 · Fax 678-236-0374
Mailing address
5565 Bankers AvenueBaton Rouge, LA 70808
Phone 225-766-3977 · Fax 225-766-3988
Authorized official
Debra W. Lockwood
President & Chief Financial Officer
2257663977
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