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General NPI Number Information
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NPI Number | 1407158231
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Entity Type | Organization
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Legal Business Name | MCKNIGHT PERSONAL CARE HOME INC,
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 11/30/2010
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Provider Practice Location Address
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Address Line | 3045 CARRIAGE TRL
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City | JONESBORO
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State | GA
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Zip | 30236-6835
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Country | US
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Telephone | 678-519-2115
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Fax | 678-216-0311
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Provider Business Mailing Address
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Address Line | 3045 CARRIAGE TRL
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City | JONESBORO
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State | GA
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Zip | 30236-6835
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Country | US
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Telephone | 678-519-2115
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Fax | 678-216-0311
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Authorized Official
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Title or Position | DIRECTOR
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Name | SHANTERIA LASHUN MCKNIGHT
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Credential |
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Telephone | 678-643-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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