Organization
JESUP HEALTHCARE LLC
Active
Other names
Jesup HealthCare
Organization subpart
No
Provider details
NPI number
Authorized official
TYGH ANGWIN BROGDON (MANAGER)
(770) 650-8773
Entity
Organization
Contact information
Practice address
3100 SAVANNAH HWY, JESUP, GA 31545-5514
(912) 427-6873
(912) 530-6713
Mailing address
3100 SAVANNAH HWY, JESUP, GA 31545-5514
(912) 427-6873
(912) 530-6713
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1-151-1864
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000142689A
—
GA
Enumeration date
06/10/2006
Last updated
09/29/2008
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