Organization
SOUTHERN MANOR SENIOR LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA W. SHERRER (ADMINISTRATOR)
(706) 678-3330
Entity
Organization
Contact information
Practice address
184 PINE LN, WASHINGTON, GA 30673-4035
(706) 678-3330
(706) 678-4440
Mailing address
184 PINE LN, WASHINGTON, GA 30673-4035
(706) 678-3330
(706) 678-4440
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
PCH008530
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003156697A
—
GA
05
—
003158657A
—
GA
Enumeration date
12/10/2014
Last updated
11/13/2015
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