| NPI | 1629411277 |
|---|---|
| Doing Business As | BOLTON LIVING AGENCY |
| Entity Type | Organization |
| Authorized Contact | ZEPHANIAH DWAYNE BAKER President 706-587-3906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: CLA001048) |
| Additional Taxonomies | 251E00000X Home Health (Licence: GA 038-R-1778) |
| 314000000X Skilled Nursing Facility (Licence: GA 038-R-1778) | |
| Enumeration Date | 2013-04-14 |
| Last Update Date | 2017-02-08 |