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General NPI Number Information
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NPI Number | 1407567084
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Entity Type | Organization
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Legal Business Name | NELSON PERSONAL CARE HOME LLC
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 4577 HOWELL FARMS RD NW
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City | ACWORTH
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State | GA
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Zip | 30101-8860
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Country | US
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Telephone | 770-771-2432
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Fax |
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Provider Business Mailing Address
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Address Line | 4577 HOWELL FARMS RD NW
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City | ACWORTH
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State | GA
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Zip | 30101-8860
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CLAUDIA ROGER
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Credential |
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Telephone | 770-771-2432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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