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General NPI Number Information
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NPI Number | 1053934802
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Entity Type | Organization
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Legal Business Name | SIMPLICITYS PERSONAL CARE HOME LLC
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Dates
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Enumeration Date | 05/27/2020
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Last Update Date | 05/27/2020
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Provider Practice Location Address
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Address Line | 6741 CHURCH ST STE 2
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City | RIVERDALE
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State | GA
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Zip | 30274-2249
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Country | US
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Telephone | 678-886-7320
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11
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City | ATLANTA
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State | GA
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Zip | 30301-0011
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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 | ADMINISTRATOR
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Name | VALERIE RACHEL
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Credential |
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Telephone | 678-886-7320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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