# MONTEZUMA HEALTH CARE CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Montezuma Health Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477574077
- **Authorized official:** JACKIE CRISP (ADMINISTRATOR)
- **Authorized official phone:** (478) 472-8168

## Contact information

- **Practice address:** 506 SUMTER ST, MONTEZUMA, GA 31063-1734
- **Practice address phone:** (478) 472-8168
- **Practice address fax:** (478) 472-2373
- **Mailing address:** PO BOX 639, MONTEZUMA, GA 31063-0639
- **Mailing address phone:** (478) 472-8168
- **Mailing address fax:** (478) 472-2373

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 385H00000X | Respite Care | 1-094-1731 | GA | Yes |

## Other

- **Enumeration date:** 07/21/2006
- **Last updated:** 06/24/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 287282627A | — | GA |