Provider Demographics
NPI:1609072131
Name:FAMILY EXTENDED CARE OF ALBANY, INC.
Entity Type:Organization
Organization Name:FAMILY EXTENDED CARE OF ALBANY, INC.
Other - Org Name:EVERGREEN ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-342-0566
Mailing Address - Street 1:2821 GILLIONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-2951
Mailing Address - Country:US
Mailing Address - Phone:229-889-8840
Mailing Address - Fax:229-434-0780
Practice Address - Street 1:2821 GILLIONVILLE RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-2951
Practice Address - Country:US
Practice Address - Phone:229-889-8840
Practice Address - Fax:229-434-0780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility