PROVIDENT GROUP - CREEKSIDE PROPERTIES LLC (NPI# 1891287645) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891287645 |
| Entity Type | Organization |
| Organization Name | PROVIDENT GROUP - CREEKSIDE PROPERTIES LLC |
| Other Organization Name | PROVIDENT VILLAGE AT CREEKSIDE |
| Practice Address |
4838 South Cobb Drive Smyrna GA 30080 |
| Mailing Address |
5565 Bankers Avenue Baton Rouge LA 70808 |
| Practice Telephone | 6787101834 |
| Practice Fax Number | 6782360374 |
| Mailing Telephone | 2257663977 |
| Mailing Fax Number | 2257663988 |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2018-06-06 |
| Authorized Official Name | DEBRA W. LOCKWOOD (PRESIDENT & CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 2257663977 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 311500000X | Alzheimer Center (Dementia Center) | Nursing & Custodial Care Facilities | ||
| N | 385H00000X | Respite Care | Respite Care Facility | ||
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Provident Village at Creekside | Doing Business As Name - Organization |
| Street Address |
4838 SOUTH COBB DRIVE |
| City | SMYRNA |
| State | GA |
| Zip Code | 30080 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881205169 | Suny Varughese | Nurse Practitioner | Minute Clinic, 2994 Atlanta Rd, Se, Smyrna, GA 30080 | 2020-08-11 |
| 1710490743 | Alina Rim | Registered Nurse | 4532 Chelton Ct Se, Smyrna, GA 30080 | 2017-11-13 |
| 1932626488 | Richard Kyle Davis | Pharmacist | 2955 Atlanta Rd Se, Smyrna, GA 30080 | 2017-08-25 |
| 1982071163 | Amelia Rafaela Turrubiates-huacuja | Counselor | 1246-c Concord Rd, Suite 101, Smyrna, GA 30080 | 2015-08-24 |
| 1275919755 | Anne Waldner Rohling | Physical Therapist | 1155 Concord Rd Se Ste 210, Smyrna, GA 30080 | 2015-08-06 |
| 1790167856 | Kay Yetunde Johnson | Nurse Practitioner | 3001 Lusk Dr, Smyrna, GA 30080 | 2015-06-25 |
| 1689055436 | Anew You Couneling, LLC | Community/Behavioral Health | 3188 Atlanta Rd, Smyrna, GA 30080 | 2015-06-17 |
| 1457766370 | Trondi Jerry | Counselor | 3381 Atlanta Rd Se, Smyrna, GA 30080 | 2014-06-30 |
| 1093081903 | Ashish Kapila | Podiatrist | Wellstar Podiatry, 4441 Atlanta Rd Se Suite 215, Smyrna, GA 30080 | 2012-03-25 |
| 1720368814 | Rophe Medics Clinic | Family Medicine | 3001 South Cobb Drive, Siute 205, Smyrna, GA 30080 | 2011-08-22 |
| Find all providers in zip 30080 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649734906 | Emerald Group LLC | Assisted Living Facility | 10540 Cedar Grove Rd, Smyrna, TN 37167-6555 | 2019-01-30 |
| 1376986919 | Serenity- A New Hope Assisted Living Community | Assisted Living Facility | 1418 Spring St Se, Smyrna, GA 30080-3639 | 2013-04-14 |
| 1194124149 | Delmar Gardens of Smyrna, LLC | Assisted Living Facility | 404 King Springs Village Pkwy Se, Smyrna, GA 30082-4240 | 2014-08-15 |
| 1720034028 | Smyrna Residential, LLC | Assisted Living Facility | 207 Commerce Dr, Smyrna, TN 37167-3024 | 2006-05-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609475086 | The We Care Homecare Foundation, Inc | Assisted Living Facility | 5701 Mableton Pkwy Sw Ste 306, Mableton, GA 30126-3360 | 2020-10-18 |
| 1871100412 | Forever Harmony PCh Inc | Assisted Living Facility | 205 Providence Walk Ct, Canton, GA 30114-8622 | 2020-09-28 |
| 1063026953 | New Hope Living Centre Dba The Fite Living Centre | Assisted Living Facility | 5 Fite St, Cartersville, GA 30120-3408 | 2020-09-08 |
| 1033723697 | Jordan Scott Seamans | Assisted Living Facility | 7778 Schomburg Rd Apt 610, Columbus, GA 31909-1928 | 2020-09-01 |
| 1225641368 | Renaissance Gainesville 1, LLC | Assisted Living Facility | 2215 Old Hamilton Pl, Gainesville, GA 30507-7893 | 2020-08-28 |
| 1770193120 | Simply Living Personal Care Home, LLC | Assisted Living Facility | 3 Berwick Ct, Savannah, GA 31406-6721 | 2020-07-31 |
| 1487276184 | 1115 Smith Opco LLC | Assisted Living Facility | 135 Market St, Thomasville, GA 31792-5782 | 2020-05-15 |
| 1497376545 | Shawitekia Johnson | Assisted Living Facility | 312 Magnolia Dr, Thomson, GA 30824-1842 | 2020-04-29 |
| 1366075848 | Liagiba, Inc | Assisted Living Facility | 518 Lake Michele Ct, Stone Mountain, GA 30088-1401 | 2020-02-13 |
| 1639701352 | Angels Live Here Inc. | Assisted Living Facility | 89 Level Creek Rd, Suwanee, GA 30024-1779 | 2020-02-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.