Healthcare Provider Details

I. General information

NPI: 1154515906
Provider Name (Legal Business Name): SILVERCREST PERSONAL CARE HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

6720 PRINCETON PARK WALK
LITHONIA GA
30058-7031
US

IV. Provider business mailing address

6720 PRINCETON PARK WALK
LITHONIA GA
30058-7031
US

V. Phone/Fax

Practice location:
  • Phone: 770-484-3034
  • Fax:
Mailing address:
  • Phone: 770-484-3034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateGA

VIII. Authorized Official

Name: MS. ROSETTA JOHNSON
Title or Position: OWNER
Credential:
Phone: 770-484-3034