Provider Demographics
NPI:1871884734
Name:TENUTO PROPERTIES LLC
Entity type:Organization
Organization Name:TENUTO PROPERTIES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-622-3065
Mailing Address - Street 1:2501 CALLIER SPRINGS RD SE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-6605
Mailing Address - Country:US
Mailing Address - Phone:706-622-3065
Mailing Address - Fax:678-490-3815
Practice Address - Street 1:2501 CALLIER SPRINGS RD SE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-6605
Practice Address - Country:US
Practice Address - Phone:706-622-3065
Practice Address - Fax:678-490-3815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057-R-0853253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care