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General NPI Number Information
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NPI Number | 1346679180
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Entity Type | Organization
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Legal Business Name | AD&S PERSONAL CARE HOME, INC.
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Dates
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Enumeration Date | 11/02/2013
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Last Update Date | 11/02/2013
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Provider Practice Location Address
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Address Line | 624 MAXWELL ST
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City | HINESVILLE
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State | GA
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Zip | 31313-4213
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Country | US
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Telephone | 912-877-5488
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Fax | 912-877-5464
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Provider Business Mailing Address
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Address Line | 3685 SUMMIT TRCE
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City | DECATUR
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State | GA
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Zip | 30034-3846
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Country | US
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Telephone | 404-862-1303
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Fax | 404-212-1495
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Authorized Official
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Title or Position | CO-OWNER/SECRETARY
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Name | MR. JAMES MONTGOMERY
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Credential |
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Telephone | 404-862-1303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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License Number State |
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