Provider Demographics
NPI:1992265193
Name:BIBB ALC LLC
Entity type:Organization
Organization Name:BIBB ALC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:SOLMEO
Authorized Official - Last Name:VICEDA
Authorized Official - Suffix:
Authorized Official - Credentials:FACILITY DIRECTOR
Authorized Official - Phone:478-254-7900
Mailing Address - Street 1:4901 HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-4135
Mailing Address - Country:US
Mailing Address - Phone:478-254-7900
Mailing Address - Fax:478-254-7895
Practice Address - Street 1:4901 HARRISON RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-4135
Practice Address - Country:US
Practice Address - Phone:478-254-7900
Practice Address - Fax:478-254-7895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility