Healthcare Provider Details

I. General information

NPI: 1629216916
Provider Name (Legal Business Name): MOUNT PLEASANT ASSISTED LIVING CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 JOHNSON AVE
THOMSON GA
30824-2043
US

IV. Provider business mailing address

311 JOHNSON AVE
THOMSON GA
30824-2043
US

V. Phone/Fax

Practice location:
  • Phone: 706-595-8537
  • Fax: 706-595-8537
Mailing address:
  • Phone: 706-595-8537
  • Fax: 706-595-8537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number097-02-007-1
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number097-02-007-1
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number097-02-007-1
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number097-02-007-1
License Number StateGA

VIII. Authorized Official

Name: MR. WILLIAM JOEL MAY
Title or Position: OWNER
Credential:
Phone: 706-598-0268