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General NPI Number Information
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NPI Number | 1720485741
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Entity Type | Organization
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Legal Business Name | POLITE HOMES LLC
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 1382 WALTON LOOP
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City | HEPHZIBAH
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State | GA
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Zip | 30815-8914
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Country | US
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Telephone | 706-504-7115
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Fax |
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Provider Business Mailing Address
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Address Line | 1382 WALTON LOOP
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City | HEPHZIBAH
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State | GA
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Zip | 30815-8914
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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 | ADMINISTRATOR
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Name | CRYSTAL RENEE POLITE
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Credential |
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Telephone | 706-504-7115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | LBC20140001185
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License Number State | GA
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