Provider Demographics
NPI:1790902518
Name:BENNETTS LANDING INC
Entity Type:Organization
Organization Name:BENNETTS LANDING INC
Other - Org Name:SUMMER WILLOW ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-562-4325
Mailing Address - Street 1:259 NUNEZ LEXSY RD
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-5170
Mailing Address - Country:US
Mailing Address - Phone:912-562-4325
Mailing Address - Fax:912-562-7061
Practice Address - Street 1:259 NUNEZ LEXSY RD
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-5170
Practice Address - Country:US
Practice Address - Phone:912-562-4325
Practice Address - Fax:912-562-7061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
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