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General NPI Number Information
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NPI Number | 1730439159
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Entity Type | Organization
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Legal Business Name | COMFORT ZONE PERSONAL CARE HOME LLC
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Dates
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Enumeration Date | 09/13/2012
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 485 FROG RD
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City | LOCUST GROVE
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State | GA
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Zip | 30248-3505
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Country | US
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Telephone | 678-610-5498
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Fax | 678-610-5498
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Provider Business Mailing Address
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Address Line | 301 STONE RD
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City | MCDONOUGH
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State | GA
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Zip | 30253-7267
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Country | US
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Telephone | 770-712-9308
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Fax | 678-610-5498
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. MARGARET WAIRIMU CLUKEY
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Credential | LPN
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Telephone | 770-712-9308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | CLA001137
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License Number State | GA
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