Healthcare Provider Details

I. General information

NPI: 1114857547
Provider Name (Legal Business Name): BET SHALOM HOUSING & HAVEN CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 PRESTON CREEK DR
MCDONOUGH GA
30253-8983
US

IV. Provider business mailing address

416 PRESTON CREEK DR
MCDONOUGH GA
30253-8983
US

V. Phone/Fax

Practice location:
  • Phone: 678-396-0120
  • Fax:
Mailing address:
  • Phone: 678-396-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA VIOLA GERARD
Title or Position: BUSINESS OWNER
Credential:
Phone: 678-396-0120