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Organization
PROVIDENT GROUP - CREEKSIDE PROPERTIES LLC
Active
Organization
PROVIDENT GROUP - CREEKSIDE PROPERTIES LLC
Active
Other names
Provident Village at Creekside
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA W. LOCKWOOD (PRESIDENT & CHIEF FINANCIAL OFFICER)
(225) 766-3977
Entity
Organization
Contact information
Practice address
4838 SOUTH COBB DRIVE, SMYRNA, GA 30080
(678) 710-1834
(678) 236-0374
Mailing address
5565 BANKERS AVENUE, BATON ROUGE, LA 70808
(225) 766-3977
(225) 766-3988
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
311500000X
Alzheimer Center (Dementia Center)
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
06/06/2018
Last updated
06/06/2018
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