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General NPI Number Information
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NPI Number | 1003409616
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Entity Type | Organization
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Legal Business Name | AT EASE PERSONAL CARE HOME, INC.
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Dates
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Enumeration Date | 02/15/2021
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Last Update Date | 02/15/2021
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Provider Practice Location Address
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Address Line | 2548 CENTRAL AVE
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City | AUGUSTA
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State | GA
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Zip | 30904-6240
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Country | US
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Telephone | 704-770-6392
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Fax | 706-723-1009
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Provider Business Mailing Address
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Address Line | 2548 CENTRAL AVE
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City | AUGUSTA
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State | GA
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Zip | 30904-6240
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Country | US
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Telephone | 704-770-6392
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Fax | 706-723-1009
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MICHAEL MIDDLETON
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Credential |
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Telephone | 704-770-6392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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