Healthcare Provider Details

I. General information

NPI: 1730375981
Provider Name (Legal Business Name): UPPER RIVER PERSONAL CARE HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 UPPER RIVER RD
COVINGTON GA
30016-3346
US

IV. Provider business mailing address

130 UPPER RIVER RD
COVINGTON GA
30016-3346
US

V. Phone/Fax

Practice location:
  • Phone: 770-784-7757
  • Fax:
Mailing address:
  • Phone: 770-784-7757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROL MERCEDES MEIKLE MCDONALD
Title or Position: PRESIDENT ADMINISTRATOR
Credential:
Phone: 770-784-7757