Provider Demographics
NPI:1215213319
Name:THE GRIFFIN HOUSE, LLC
Entity Type:Organization
Organization Name:THE GRIFFIN HOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-739-4000
Mailing Address - Street 1:4 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:CLAXTON
Mailing Address - State:GA
Mailing Address - Zip Code:30417-1724
Mailing Address - Country:US
Mailing Address - Phone:912-739-4000
Mailing Address - Fax:912-739-4404
Practice Address - Street 1:107 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-2005
Practice Address - Country:US
Practice Address - Phone:912-739-4000
Practice Address - Fax:912-739-4404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054020021310400000X
GA054030021311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility