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General NPI Number Information
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NPI Number | 1013223098
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Entity Type | Organization
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Legal Business Name | MY HOUSE INC
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Dates
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Enumeration Date | 08/27/2010
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 2721 RAVEN WOOD DR
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City | SNELLVILLE
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State | GA
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Zip | 30078-3739
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Country | US
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Telephone | 770-978-0791
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Fax | 678-325-1529
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Provider Business Mailing Address
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Address Line | 2721 RAVENWOOD DRIVE
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City | SNELLVILLE
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State | GA
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Zip | 30078
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Country | US
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Telephone | 770-978-0791
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Fax | 678-325-1529
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Authorized Official
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Title or Position | DIRECTOR
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Name | DONNA RENEE BRAZIL
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Credential |
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Telephone | 770-978-0791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 067011511
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License Number State | GA
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