Healthcare Provider Details

I. General information

NPI: 1740950187
Provider Name (Legal Business Name): FAMILY PERSONAL CARE HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 TANNERS BRIDGE RD
BETHLEHEM GA
30620-3321
US

IV. Provider business mailing address

294 TANNERS BRIDGE RD
BETHLEHEM GA
30620-3321
US

V. Phone/Fax

Practice location:
  • Phone: 770-633-3822
  • Fax:
Mailing address:
  • Phone: 770-633-3822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JOY MURRAY
Title or Position: DIRECTOR
Credential:
Phone: 770-633-3822