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General NPI Number Information
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NPI Number | 1407191257
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Entity Type | Organization
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Legal Business Name | LITCHFIELD HOMES LLC
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Dates
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Enumeration Date | 12/05/2012
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 4925 BRIDLE POINT PKWY
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City | SNELLVILLE
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State | GA
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Zip | 30039-3343
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Country | US
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Telephone | 404-248-7945
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Fax | 770-679-0617
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Provider Business Mailing Address
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Address Line | 4238 VILLAGE SQUARE LN
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-4270
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Country | US
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Telephone | 404-248-7945
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Fax | 770-679-0617
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MS. COLLEEN ANN BACCHUS
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Credential |
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Telephone | 404-468-6469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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