Organization
PHENOMENAL LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JERALDINE GENEVA LOVE CERTIFIED NURSING AS (OWNER)
(912) 436-5110
Entity
Organization
Contact information
Practice address
2410 BON AIR DR, SAVANNAH, GA 31406-2908
(912) 328-7679
(912) 234-0493
Mailing address
2410 BON AIR DR, SAVANNAH, GA 31406-2908
(912) 328-7679
(912) 234-0493
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
CN0012346961
GA
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Enumeration date
07/24/2018
Last updated
12/17/2020
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