Healthcare Provider Details

I. General information

NPI: 1821268681
Provider Name (Legal Business Name): KEITH'S PLACE PERSONAL CARE HOME,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2594 HOLLY BERRY TRL
SNELLVILLE GA
30039-4331
US

IV. Provider business mailing address

2594 HOLLY BERRY TRL
SNELLVILLE GA
30039-4331
US

V. Phone/Fax

Practice location:
  • Phone: 678-395-3482
  • Fax:
Mailing address:
  • Phone: 678-395-3482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LEESHELL ALEXANDER
Title or Position: DIRECTOR
Credential:
Phone: 404-447-3989