Healthcare Provider Details

I. General information

NPI: 1639392954
Provider Name (Legal Business Name): PAM'S CHRISTIAN CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 W MAIN ST
LAKELAND GA
31635-1421
US

IV. Provider business mailing address

503 W MAIN ST
LAKELAND GA
31635-1421
US

V. Phone/Fax

Practice location:
  • Phone: 229-482-8164
  • Fax: 229-482-1074
Mailing address:
  • Phone: 229-482-8164
  • Fax: 229-482-1074

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: PROF. PAMELA TOMBERLIN STONE
Title or Position: PRESIDENT
Credential: R.N.
Phone: 229-482-8164