Provider Demographics
NPI:1194993634
Name:BLACKSHEAR RETIREMENT VILLA ALS
Entity type:Organization
Organization Name:BLACKSHEAR RETIREMENT VILLA ALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:BRIDGES
Authorized Official - Last Name:SARATSIOTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-271-9686
Mailing Address - Street 1:902 BLACKSHEAR RD
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-3665
Mailing Address - Country:US
Mailing Address - Phone:229-271-9686
Mailing Address - Fax:229-271-9689
Practice Address - Street 1:902 BLACKSHEAR RD
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3665
Practice Address - Country:US
Practice Address - Phone:229-271-9686
Practice Address - Fax:229-271-9689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040446314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility