Organization
SUPREME TEAM LLC
Active
Other names
Longevity Personal Care Home
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CALETHA TAYLOR (MANAGER)
(706) 951-7514
Entity
Organization
Contact information
Practice address
1520 12TH ST, AUGUSTA, GA 30901-3676
(706) 364-4710
Mailing address
5327 WINDMILL PKWY, EVANS, GA 30809-6651
(706) 951-7514
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
—
GA
Other
Enumeration date
07/02/2012
Last updated
07/02/2012
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