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General NPI Number Information
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NPI Number | 1326385956
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Entity Type | Organization
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Legal Business Name | BEST CARE GROUP HOME INC.
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Dates
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Enumeration Date | 01/16/2013
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 1359 EDGEWOOD AVE
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City | DOUGLAS
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State | GA
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Zip | 31533-4543
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Country | US
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Telephone | 912-383-0054
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Fax | 912-383-0054
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Provider Business Mailing Address
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Address Line | 1359 EDGEWOOD AVE
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City | DOUGLAS
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State | GA
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Zip | 31533-4543
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Country | US
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Telephone | 912-383-0054
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Fax | 912-383-0054
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Authorized Official
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Title or Position | DIRECTOR
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Name | TRAVIS LAMONT DAVIS
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Credential | BSW
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Telephone | 305-720-3255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | CLA002023
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | CLA002023
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License Number State | GA
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