MEDICARE: SILLAH GROUP HOMES

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	310400000X	Assisted Living Facility	GA
2	3104A0625X	Assisted Living Facility (Mental Illness)	GA
3	3104A0630X	Assisted Living Facility (Behavioral Disturbances)	GA
4	311500000X	Alzheimer Center (Dementia Center)	GA
5	311ZA0620X	Adult Care Home Facility	GA
6	313M00000X	Nursing Facility/Intermediate Care Facility	GA
7	3140N1450X	Pediatric Skilled Nursing Facility	GA
8	315P00000X	Intellectual Disabilities Intermediate Care Facility	GA
9	385H00000X	Respite Care	GA
10	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	GA
11	385HR2065X	Child Physical Disabilities Respite Care	GA
12	251J00000X	Nursing Care Agency	GA

NPI Number	:	1336599307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILLAH GROUP HOMES

Provider Business Mailing Address
First Line	:	2992 W MAIN ST
Second Line	:	SUITE 106
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-5764
Country	:	US
Telephone Number	:	844-356-5005
Fax Number	:	888-745-6153

Provider Business Practice Location Address
First Line	:	2992 W MAIN ST
Second Line	:	SUITE 106
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-5764
Country	:	US
Telephone Number	:	844-356-5005
Fax Number	:	888-745-6153

Authorized Official
Title or Position	:	CEO
Name	:	SHARON PEART
Credential	:
Telephone Number	:	929-432-9025

Provider Enumeration Date	:	06/20/2016
Last Update Date	:	06/20/2016

2992 MAIN ST W , SUITE A100
SNELLVILLE, GA
30078-5764

Practice Phone: 770-972-1039
Practice Fax: 770-979-3903