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General NPI Number Information
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NPI Number | 1013241322
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Entity Type | Organization
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Legal Business Name | ASSISTED LIVING CORPORATION OF GA
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Dates
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Enumeration Date | 09/21/2009
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Last Update Date | 09/21/2009
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Provider Practice Location Address
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Address Line | 149 SHADY LN
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City | CANTON
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State | GA
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Zip | 30114-7960
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Country | US
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Telephone | 404-790-5956
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Fax |
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Provider Business Mailing Address
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Address Line | 794 MIDDLEBROOK DR
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City | JONESBORO
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State | GA
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Zip | 30236-2020
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIKE LASITER
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Credential |
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Telephone | 404-790-5956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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