Healthcare Provider Details

I. General information

NPI: 1346385192
Provider Name (Legal Business Name): DIGNITY PLACE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 KINGSFORD XING
ACWORTH GA
30101-2669
US

IV. Provider business mailing address

252 KINGSFORD XING
ACWORTH GA
30101-2669
US

V. Phone/Fax

Practice location:
  • Phone: 404-513-0399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number110-R-0289
License Number StateGA

VIII. Authorized Official

Name: LA MONIQUE RUTH BENFORD
Title or Position: EXE. DIR.
Credential:
Phone: 404-513-0399