Provider Demographics
NPI:1083603609
Name:SUMMERHILL, LLC
Entity Type:Organization
Organization Name:SUMMERHILL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:478-988-1294
Mailing Address - Street 1:1211 MACON RD
Mailing Address - Street 2:STE D
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2679
Mailing Address - Country:US
Mailing Address - Phone:478-988-1294
Mailing Address - Fax:478-988-1193
Practice Address - Street 1:500 STANLEY ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-3145
Practice Address - Country:US
Practice Address - Phone:478-987-3100
Practice Address - Fax:478-987-0664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-076-1106314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000142139BMedicaid
GA000142139AMedicaid
GA115430Medicare ID - Type Unspecified
GA000142139BMedicaid
GA000142139AMedicaid