Provider Demographics
NPI:1376722116
Name:TUCKER INVESTMENTS & ASSOCIATES LLC
Entity Type:Organization
Organization Name:TUCKER INVESTMENTS & ASSOCIATES LLC
Other - Org Name:GRACE HEALTHCARE OF TUCKER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CLARK DANKS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:423-308-1845
Mailing Address - Street 1:2165 IDLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4816
Mailing Address - Country:US
Mailing Address - Phone:770-934-3172
Mailing Address - Fax:
Practice Address - Street 1:2165 IDLEWOOD RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4816
Practice Address - Country:US
Practice Address - Phone:770-934-3172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10441434314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA115596Medicare Oscar/Certification