Organization
SOUTHERN PINES RETIREMENT VILLA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS SANDRA RICHARDSON (OWNER)
(478) 279-3286
Entity
Organization
Contact information
Practice address
345 PERRY HWY., HAWKINSVILLE, GA 31036
(478) 783-3445
(478) 783-3545
Mailing address
345 PERRY HWY., HAWKINSVILLE, GA 31036
(478) 783-3445
(478) 783-3545
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
311Z00000X
Custodial Care Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116-01-001-1
PERSONAL CARE HOME PERM.
GA
Enumeration date
04/14/2021
Last updated
04/08/2022
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