Provider Demographics
NPI:1174770424
Name:MIONA GERIATRIC AND DEMENTIA CENTER, LLC
Entity type:Organization
Organization Name:MIONA GERIATRIC AND DEMENTIA CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JULE
Authorized Official - Last Name:WINDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-967-2223
Mailing Address - Street 1:777 NURSING HOME RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31057-3715
Mailing Address - Country:US
Mailing Address - Phone:478-967-2223
Mailing Address - Fax:
Practice Address - Street 1:201 POPLAR ST
Practice Address - Street 2:
Practice Address - City:IDEAL
Practice Address - State:GA
Practice Address - Zip Code:31041-6264
Practice Address - Country:US
Practice Address - Phone:478-949-2270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition