Provider Demographics
NPI:1477996254
Name:GERDIE AND LOUISE PERSONAL CARE HOME, L.L.C.
Entity Type:Organization
Organization Name:GERDIE AND LOUISE PERSONAL CARE HOME, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-678-2901
Mailing Address - Street 1:2064 PINEMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30461-2358
Mailing Address - Country:US
Mailing Address - Phone:912-489-2575
Mailing Address - Fax:912-489-2583
Practice Address - Street 1:1223 NEWINGTON HWY
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:GA
Practice Address - Zip Code:30467-2703
Practice Address - Country:US
Practice Address - Phone:912-978-0267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACLA000920251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health