Provider Demographics
NPI:1790055903
Name:THE KNIGHT GROUP INCORPORATED OF GEORGIA
Entity Type:Organization
Organization Name:THE KNIGHT GROUP INCORPORATED OF GEORGIA
Other - Org Name:KNIGHTS MANOR PERSONAL CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-762-3150
Mailing Address - Street 1:382 JOWERS RD
Mailing Address - Street 2:PO BOX 409
Mailing Address - City:WHIGHAM
Mailing Address - State:GA
Mailing Address - Zip Code:39897-2162
Mailing Address - Country:US
Mailing Address - Phone:229-762-3150
Mailing Address - Fax:229-762-3110
Practice Address - Street 1:382 JOWERS RD
Practice Address - Street 2:
Practice Address - City:WHIGHAM
Practice Address - State:GA
Practice Address - Zip Code:39897-2162
Practice Address - Country:US
Practice Address - Phone:229-762-3150
Practice Address - Fax:229-762-3110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA065010161261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health