Healthcare Provider Details

I. General information

NPI: 1689860256
Provider Name (Legal Business Name): PHILPOT PERSONAL CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 CASCADE RD SW
ATLANTA GA
30331-7348
US

IV. Provider business mailing address

4760 CASCADE RD SW
ATLANTA GA
30331-7348
US

V. Phone/Fax

Practice location:
  • Phone: 404-625-1688
  • Fax: 404-699-9807
Mailing address:
  • Phone: 404-625-1688
  • Fax: 404-699-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHERYL ANN GLASS
Title or Position: ADMINISTRATOR
Credential:
Phone: 404-625-1688