Provident Group - Creekside Properties LLC

NPI #1891287645 in Smyrna, Georgia

Provider Information

NPI Number
1891287645
Entity Type
Organization
Organization Name
Provident Group - Creekside Properties LLC
Primary Specialty
Assisted Living Facility
Enumeration Date
Jun 6, 2018
Last Updated
Jun 6, 2018

Practice Location

Address
4838 SOUTH COBB DRIVE
City
Smyrna
State
Georgia
ZIP Code
30080
Phone
(678) 710-1834

Authorized Official

Name
DEBRA W. LOCKWOOD
Title
PRESIDENT & CHIEF FINANCIAL OFFICER
Phone
(225) 766-3977

Specialties & Taxonomy Codes

Specialty
Alzheimer Center (Dementia Center)
Respite Care
Assisted Living Facility

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