Healthcare Provider Details

I. General information

NPI: 1154218014
Provider Name (Legal Business Name): BARKSDALE PERSONAL CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 N OLIVER ST
ELBERTON GA
30635-1444
US

IV. Provider business mailing address

242 N OLIVER ST
ELBERTON GA
30635-1444
US

V. Phone/Fax

Practice location:
  • Phone: 706-567-8491
  • Fax: 706-567-8491
Mailing address:
  • Phone: 706-567-8491
  • Fax: 706-567-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: CASSANDRA D BARKSDALE
Title or Position: CEO
Credential:
Phone: 706-567-8491