Provider Demographics
NPI:1629567797
Name:ST JAMES PLACE, INC
Entity Type:Organization
Organization Name:ST JAMES PLACE, INC
Other - Org Name:ST JAMES PLACE, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLARD-MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-315-7723
Mailing Address - Street 1:2027 ALTA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-3213
Mailing Address - Country:US
Mailing Address - Phone:706-221-8578
Mailing Address - Fax:706-221-9206
Practice Address - Street 1:2027 ALTA VISTA DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-3213
Practice Address - Country:US
Practice Address - Phone:706-221-8578
Practice Address - Fax:706-221-9206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000982022AMedicaid