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General NPI Number Information
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NPI Number | 1538603824
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Entity Type | Organization
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Legal Business Name | ESSENCE PERSONAL CARE HOME
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Dates
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Enumeration Date | 12/06/2016
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 206 FLOWING WELLS RD
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City | MARTINEZ
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State | GA
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Zip | 30907-2140
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Country | US
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Telephone | 803-646-5174
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Fax |
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Provider Business Mailing Address
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Address Line | 206 FLOWING WELLS RD
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City | MARTINEZ
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State | GA
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Zip | 30907-2140
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Country | US
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Telephone | 803-646-5174
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LASHONDA RENEE SWEDENBURG
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Credential |
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Telephone | 803-646-5174
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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 | PCH008654
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License Number State | GA
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