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General NPI Number Information
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NPI Number | 1326577255
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Entity Type | Organization
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Legal Business Name | MONTICELLO PERSONAL CARE HOME
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 825 EATONTON ST
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City | MONTICELLO
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State | GA
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Zip | 31064-1029
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Country | US
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Telephone | 706-875-7944
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Fax |
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Provider Business Mailing Address
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Address Line | 825 EATONTON ST
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City | MONTICELLO
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State | GA
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Zip | 31064-1029
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Country | US
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Telephone | 706-875-7944
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Fax |
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Authorized Official
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Title or Position | CORPORATE ADMINISTRATIVE ASSISTANT
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Name | ANNA COTTON
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Credential |
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Telephone | 770-692-3875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | PCH009112
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License Number State | GA
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