Organization
IMMANUEL HOUSE PERSONAL CARE HOME, LLC
Active
Other names
Immanuel House Personal Care Home, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY WIGGS LPN (DIRECTOR)
(740) 600-0004
Entity
Organization
Contact information
Practice address
422 N WASHINGTON STREET, MOUNT VERNON, GA 30445
(740) 600-0004
Mailing address
134 TEATSWORTH DR, CHILLICOTHE, OH 45601-2752
(740) 600-0004
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
—
—
Other
Enumeration date
07/07/2023
Last updated
07/07/2023
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