Provider Demographics
NPI:1689186223
Name:MAJESTIC SENIOR LIVING TENNILLE LLC
Entity Type:Organization
Organization Name:MAJESTIC SENIOR LIVING TENNILLE LLC
Other - Org Name:MAJESTIC SENIOR LIVING TENNILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-222-0417
Mailing Address - Street 1:2451 CUMBERLAND PKWY SE STE 3560
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TENNILLE
Practice Address - State:GA
Practice Address - Zip Code:31089-1438
Practice Address - Country:US
Practice Address - Phone:478-552-8881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAJESTIC SENIOR LIVING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility