Organization
GLASCOCK COUNTY HEALTH CARE LLC
Active
Other names
The Southern Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
JIMMIE STEWART (ADMINISTRATOR)
(706) 598-2167
Entity
Organization
Contact information
Practice address
434 BEALL SPRINGS RD, GIBSON, GA 30810-4224
(706) 598-2167
(706) 598-3802
Mailing address
PO BOX 248, GIBSON, GA 30810-0248
(706) 598-2167
(706) 598-3802
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
062-02-001-1
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000258706A
—
GA
Enumeration date
09/09/2005
Last updated
05/24/2011
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