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General NPI Number Information
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NPI Number | 1073958252
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Entity Type | Organization
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Legal Business Name | VAULEET'S PERSONAL CARE HOME, LLC
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Dates
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Enumeration Date | 05/01/2013
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 2811 BLUE GRASS LN
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City | DECATUR
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State | GA
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Zip | 30034-3310
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Country | US
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Telephone | 770-865-1509
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Fax |
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Provider Business Mailing Address
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Address Line | 2811 BLUE GRASS LN
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City | DECATUR
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State | GA
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Zip | 30034-3310
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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 | OWNER/CEO
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Name | KAY LEITCH
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Credential | LPN
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Telephone | 770-865-1509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 060-R-1165
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License Number State | GA
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