Organization
COVINGTON MANOR NURSING HOME LLC
Active
Parent organization
COVINGTON MANOR NURSING HOME LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
COVINGTON MANOR NURSING HOME LLC
Authorized official
RONNIE CRUMP (OWNER)
(478) 783-1623
Entity
Organization
Contact information
Practice address
440 INDUSTRIAL BLVD, HAWKINSVILLE, GA 31036
(478) 783-4988
Mailing address
PO BOX 1038, HAWKINSVILLE, GA 31036-7038
(478) 783-4988
Taxonomy
Speciality
Code
Description
License number
State
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
106867
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000515534A
—
GA
Enumeration date
06/27/2007
Last updated
01/02/2009
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