Organization
1115 SMITH OPCO LLC
Active
Other names
The Residence at Oak Grove
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN PERSON (DIRECTOR OF BUSINESS DEVELOPMENT)
(260) 413-4159
Entity
Organization
Contact information
Practice address
135 MARKET ST, THOMASVILLE, GA 31792-5782
(229) 222-9155
Mailing address
3630 ILLINOIS RD, FORT WAYNE, IN 46804-2062
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
05/15/2020
Last updated
05/15/2020
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