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General NPI Number Information
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NPI Number | 1396135661
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Entity Type | Organization
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Legal Business Name | YAHWEH A PERSONAL CARE HOME
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Dates
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Enumeration Date | 01/26/2015
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Last Update Date | 01/26/2015
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Provider Practice Location Address
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Address Line | 8194 SAXON CT
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City | JONESBORO
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State | GA
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Zip | 30238-3020
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Country | US
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Telephone | 404-993-4404
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Fax |
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Provider Business Mailing Address
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Address Line | 921 WESTMORELAND CIR NW APT 5302
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City | ATLANTA
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State | GA
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Zip | 30318-4030
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Country | US
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Telephone | 404-993-4404
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LANAY LEESHAWN WILLIAMS
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Credential | OWNER
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Telephone | 404-993-4404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | PCH008552
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License Number State | GA
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