| NPI | 1154628790 |
|---|---|
| Doing Business As | GRAND LAKE VILLA |
| Entity Type | Organization |
| Authorized Contact | CHRIS BROGDON Manager 770-650-8793 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2011-02-17 |
| Last Update Date | 2022-01-19 |