Provider Demographics
NPI:1124396924
Name:TDG GRANT ENTERPRISES LLC
Entity Type:Organization
Organization Name:TDG GRANT ENTERPRISES LLC
Other - Org Name:GOLDEN DAYS QUALITY CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:CARVER
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:706-374-1360
Mailing Address - Street 1:PO BOX 541
Mailing Address - Street 2:
Mailing Address - City:MINERAL BLUFF
Mailing Address - State:GA
Mailing Address - Zip Code:30559-0541
Mailing Address - Country:US
Mailing Address - Phone:706-374-1360
Mailing Address - Fax:
Practice Address - Street 1:940 KNOLLWOOD RD
Practice Address - Street 2:
Practice Address - City:MINERAL BLUFF
Practice Address - State:GA
Practice Address - Zip Code:30559-3012
Practice Address - Country:US
Practice Address - Phone:706-374-1360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCH006042310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility