Provider Demographics
NPI:1972265452
Name:GEORGIAN GARDENS HEALTHCARE LLC
Entity Type:Organization
Organization Name:GEORGIAN GARDENS HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BENARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PERLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-928-3278
Mailing Address - Street 1:110 ROCKAWAY TPKE STE 6
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1626
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 GEORGIAN GARDENS DR
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-1436
Practice Address - Country:US
Practice Address - Phone:573-438-6261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility