Provider Demographics
NPI:1346547858
Name:BETTY'S ASSISTED LIVING HOME,LLC
Entity Type:Organization
Organization Name:BETTY'S ASSISTED LIVING HOME,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:NIPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-331-0922
Mailing Address - Street 1:603 WARD ST E
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-0301
Mailing Address - Country:US
Mailing Address - Phone:912-331-0922
Mailing Address - Fax:
Practice Address - Street 1:603 WARD ST E
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-0301
Practice Address - Country:US
Practice Address - Phone:912-331-0922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health