Healthcare Provider Details

I. General information

NPI: 1326385956
Provider Name (Legal Business Name): BEST CARE GROUP HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1359 EDGEWOOD AVE
DOUGLAS GA
31533-4543
US

IV. Provider business mailing address

1359 EDGEWOOD AVE
DOUGLAS GA
31533-4543
US

V. Phone/Fax

Practice location:
  • Phone: 912-383-0054
  • Fax: 912-383-0054
Mailing address:
  • Phone: 912-383-0054
  • Fax: 912-383-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberCLA002023
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License NumberCLA002023
License Number StateGA

VIII. Authorized Official

Name: TRAVIS LAMONT DAVIS
Title or Position: DIRECTOR
Credential: BSW
Phone: 305-720-3255