Organization
TENNILLE RETIREMENT HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMASON BYRD (VICE PRESIDENT)
(478) 862-9051
Entity
Organization
Contact information
Practice address
525 N MAIN ST, TENNILLE, GA 31089-1128
(478) 862-9051
Mailing address
PO BOX 2028, BUTLER, GA 31006-2028
(478) 862-9051
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
150-03-001-1
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115769937A
—
GA
Enumeration date
06/30/2010
Last updated
06/30/2010
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