=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083592406
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BELLAMERE MANORS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2025
-----------------------------------------------------
Last Update Date | 08/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8647 FOREST POINTE DR
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30238-4362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-240-7474
-----------------------------------------------------
Fax | 678-550-9322
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1223
-----------------------------------------------------
City | GRAYSON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30017-0024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-481-5804
-----------------------------------------------------
Fax | 678-550-9233
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MARY COLE
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 678-481-5804
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------