Organization
TREUTLEN COUNTY NURSING HOME LLC
Active
Other names
Treutlen Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNNIE BROOKS (ADMINISTRATOR)
(912) 529-4418
Entity
Organization
Contact information
Practice address
5590 N 3RD ST, SOPERTON, GA 30457-2007
(912) 529-4418
(912) 529-3322
Mailing address
5590 N 3RD ST, SOPERTON, GA 30457-2007
(912) 529-4418
(912) 529-3322
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
140-02-001-1
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000404027A
—
GA
Enumeration date
05/24/2011
Last updated
05/24/2011
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