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General NPI Number Information
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NPI Number | 1629339361
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Entity Type | Organization
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Legal Business Name | DIGNITY CARE HOMES, LLC
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 05/30/2012
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Provider Practice Location Address
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Address Line | 603 EFFIE DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-3808
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Country | US
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Telephone | 678-629-3267
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Fax |
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Provider Business Mailing Address
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Address Line | 603 EFFIE DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-3808
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Country | US
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Telephone | 678-629-3267
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. BEVERLY AGEE BARNWELL
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Credential |
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Telephone | 678-629-3267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 2011015696
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License Number State | GA
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