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General NPI Number Information
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NPI Number | 1023823960
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Entity Type | Organization
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Legal Business Name | DRD PRIVATE HOME CARE
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 7712 AUTRY CIR APT 310
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-5730
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Country | US
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Telephone | 470-276-4515
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Fax | 470-228-5106
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Provider Business Mailing Address
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Address Line | 7712 AUTRY CIR APT 310
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-5730
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Country | US
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Telephone | 470-276-4515
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Fax | 470-228-5106
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Authorized Official
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Title or Position | MANAGER
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Name | DE'SHALAH POTTER
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Credential |
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Telephone | 470-412-0295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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