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General NPI Number Information
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NPI Number | 1235369513
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Entity Type | Organization
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Legal Business Name | CHOICE PERSONAL CARE HOME
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 07/21/2009
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Provider Practice Location Address
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Address Line | 1030 SCOTT RD
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City | RIVERDALE
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State | GA
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Zip | 30296-1558
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Country | US
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Telephone | 424-477-6536
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Fax | 770-969-5958
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Provider Business Mailing Address
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Address Line | 3850 PEBBLE BEACH DR
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City | COLLEGE PARK
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State | GA
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Zip | 30349-3632
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Country | US
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Telephone | 424-477-6536
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Fax | 770-969-5958
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Authorized Official
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Title or Position | OWNER
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Name | MRS. RUBY L LEWIS
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Credential |
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Telephone | 424-477-6536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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