Provider Demographics
NPI:1396883252
Name:LEISURE LIVING, INC
Entity type:Organization
Organization Name:LEISURE LIVING, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOETTE
Authorized Official - Middle Name:H
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:912-537-9306
Mailing Address - Street 1:1105 MOUNT VERNON RD
Mailing Address - Street 2:PO. BOX 561
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-3002
Mailing Address - Country:US
Mailing Address - Phone:912-537-9306
Mailing Address - Fax:912-538-5509
Practice Address - Street 1:1105 MOUNT VERNON RD
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-3002
Practice Address - Country:US
Practice Address - Phone:912-537-9306
Practice Address - Fax:912-538-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
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