Organization
NINA'S HAVEN PERSONAL CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY GAYLE (OWNER/ADMINISTRATOR)
(786) 370-4781
Entity
Organization
Contact information
Practice address
306 W MANN ST, GLENNVILLE, GA 30427-2040
(912) 654-1649
Mailing address
306 W MANN ST, GLENNVILLE, GA 30427-2040
(912) 654-1649
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000
NONE
—
Enumeration date
06/29/2020
Last updated
06/29/2020
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