Immanuel House Personal Care Home, LLC
NPI #1205514445 in Mount Vernon, Georgia
Provider Information
- NPI Number
- 1205514445
- Entity Type
- Organization
- Organization Name
- Immanuel House Personal Care Home, LLC
- Primary Specialty
- Licensed Practical Nurse
- Enumeration Date
- Jul 7, 2023
- Last Updated
- Jul 7, 2023
Practice Location
- Address
- 422 N WASHINGTON STREET
- City
- Mount Vernon
- State
- Georgia
- ZIP Code
- 30445
- Phone
- (740) 600-0004
Authorized Official
- Name
- KIMBERLY WIGGS, LPN
- Title
- DIRECTOR
- Phone
- (740) 600-0004
Specialties & Taxonomy Codes
| Specialty |
|---|
| Licensed Practical Nurse |
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