Provider Demographics
NPI:1437513116
Name:MARSHALL RETIREMENT CENTER
Entity Type:Organization
Organization Name:MARSHALL RETIREMENT CENTER
Other - Org Name:PERSONAL CARE HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOLLIE
Authorized Official - Middle Name:BOGGS
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:912-449-1380
Mailing Address - Street 1:P.O.B. 650
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516
Mailing Address - Country:US
Mailing Address - Phone:912-449-1380
Mailing Address - Fax:912-449-1380
Practice Address - Street 1:619 ALLEN AVENUE
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516
Practice Address - Country:US
Practice Address - Phone:912-449-1380
Practice Address - Fax:912-449-1380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome Health