Healthcare Provider Details

I. General information

NPI: 1033482369
Provider Name (Legal Business Name): A PLACE FOR COMFORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1766 BIG VALLEY LN
STONE MOUNTAIN GA
30083-5712
US

IV. Provider business mailing address

PO BOX 82542
CONYERS GA
30013-9437
US

V. Phone/Fax

Practice location:
  • Phone: 678-615-3841
  • Fax:
Mailing address:
  • Phone: 404-831-8502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberPCH001362
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberPCH001362
License Number StateGA

VIII. Authorized Official

Name: SELMA GILCREASE
Title or Position: OWNER
Credential:
Phone: 404-831-8502