Organization
PARKSIDE HOMES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WAYLAND SMITH SMITH RN (OWNER)
(229) 798-0170
Entity
Organization
Contact information
Practice address
119 4TH ST SW, MOULTRIE, GA 31768-4547
(229) 798-0170
Mailing address
PO BOX 2132, MOULTRIE, GA 31776-2132
(229) 798-0170
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
—
—
Other
Enumeration date
08/06/2013
Last updated
08/06/2013
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