Organization
COVINGTON MANOR NURSING HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD GARY CRUMP (PRESIDENT)
(770) 786-0427
Entity
Organization
Contact information
Practice address
4148 CARROLL ST SW, COVINGTON, GA 30014-2706
(770) 786-0427
(770) 385-9021
Mailing address
4148 CARROLL ST., P.O. BOX 1369, COVINGTON, GA 30014
(770) 786-0427
(770) 385-9021
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
11071744
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00265196A
—
GA
Enumeration date
09/26/2006
Last updated
08/22/2020
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