Organization
MT. KENN NURSING, LLC
Active
Other names
Autumn Breeze Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
BOYD P GENTRY JR. (PRESIDNET AND CEO)
(937) 964-8974
Entity
Organization
Contact information
Practice address
1480 SANDTOWN ROAD, MARIETTA, GA 30008-3821
(770) 442-1755
(770) 442-8784
Mailing address
5057 TROY ROAD, SPRINGFIELD, OH 45502-8150
(937) 964-8974
(937) 964-8961
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
05-47025
GA
314000000X
Skilled Nursing Facility
Primary
1-033-1982
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00140159A
—
GA
Enumeration date
05/24/2006
Last updated
07/25/2011
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