Organization
EVANS MEMORIAL HOSPITAL, INC.
Active
Other names
GLENVUE NURSING HOME
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARTHA F TATUM (CEO)
(912) 739-5105
Entity
Organization
Contact information
Practice address
721 N DOWNING MUSGROVE HWY, GLENNVILLE, GA 30427-2208
(912) 654-2141
Mailing address
721 N DOWNING MUSGROVE HWY, GLENNVILLE, GA 30427-2208
(912) 654-2141
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
11321521
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00141171A
—
GA
Enumeration date
07/18/2006
Last updated
08/22/2020
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