Provider Demographics
NPI:1184757205
Name:JBC ASSISTED LIVING GROUP HOME
Entity type:Organization
Organization Name:JBC ASSISTED LIVING GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:TERRELL
Authorized Official - Last Name:CARTWRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-825-8511
Mailing Address - Street 1:235 BIG SIX FARMS RD
Mailing Address - Street 2:
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-8528
Mailing Address - Country:US
Mailing Address - Phone:478-825-8511
Mailing Address - Fax:478-825-3757
Practice Address - Street 1:235 BIG SIX FARMS RD
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-8528
Practice Address - Country:US
Practice Address - Phone:478-825-8511
Practice Address - Fax:478-825-3757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility