Organization
ADVENT CARE SYSTEMS OF OCILLA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RYAN S. TRETTIEN (EXECUTIVE DIRECTOR)
(912) 532-9308
Entity
Organization
Contact information
Practice address
501 N IRWIN AVE, OCILLA, GA 31774-5007
(912) 433-0615
Mailing address
PO BOX 413, HINESVILLE, GA 31310-0413
(229) 468-0646
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
183500000X
Pharmacist
—
—
213E00000X
Podiatrist
—
—
213ES0000X
Sports Medicine Podiatrist
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1139398320
FQHC - IRWIN COUNTY LOW INCOME CERTIFICATION
GA
Enumeration date
05/27/2020
Last updated
09/16/2020
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