Organization
CARE OF LATRELLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY DAVIS (CREDENTIALING SPECIALISTS)
(912) 484-3879
Entity
Organization
Contact information
Practice address
127 WAVERLY WAY, SAVANNAH, GA 31407-5032
(912) 220-8105
Mailing address
127 WAVERLY WAY, SAVANNAH, GA 31407-5032
(912) 220-8105
Taxonomy
Speciality
Code
Description
License number
State
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
12/07/2016
Last updated
12/07/2016
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