Provider Demographics
NPI:1700563905
Name:TUCKER OPERATING COMPANY LLC
Entity Type:Organization
Organization Name:TUCKER OPERATING COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OF LLC
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FEIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-525-6693
Mailing Address - Street 1:2165 IDLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2165 IDLEWOOD RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4816
Practice Address - Country:US
Practice Address - Phone:770-934-3172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility