Provider Demographics
NPI:1770986622
Name:THE VILLAS AT BELLEVUE, LLC
Entity type:Organization
Organization Name:THE VILLAS AT BELLEVUE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-274-0043
Mailing Address - Street 1:411 WITHERINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:EAST DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31027-3222
Mailing Address - Country:US
Mailing Address - Phone:478-290-2905
Mailing Address - Fax:
Practice Address - Street 1:903 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-4849
Practice Address - Country:US
Practice Address - Phone:478-275-2015
Practice Address - Fax:478-275-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCH008494311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home