Organization
GEORGIA HEALTH SERVICES NETWORK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAROLYN FAGAN R.N. (CEO)
(770) 466-7771
Entity
Organization
Contact information
Practice address
155 BANKERS BLVD, BLDG A, SUITE 100, MONROE, GA 30655-7722
(770) 466-7771
Mailing address
PO BOX 2966, LOGANVILLE, GA 30052-1967
(770) 466-7771
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124697600A
—
GA
Enumeration date
10/16/2012
Last updated
10/16/2012
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