Provider Demographics
NPI:1831353671
Name:JONESBORO ASSISTED LIVING CENTER, LLC
Entity type:Organization
Organization Name:JONESBORO ASSISTED LIVING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NORBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-662-4955
Mailing Address - Street 1:2650 HIGHWAY 138 E
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2744
Mailing Address - Country:US
Mailing Address - Phone:770-603-5559
Mailing Address - Fax:770-210-1034
Practice Address - Street 1:2650 HIGHWAY 138 E
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2744
Practice Address - Country:US
Practice Address - Phone:770-603-5559
Practice Address - Fax:770-210-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility