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General NPI Number Information
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NPI Number | 1780122010
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Entity Type | Organization
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Legal Business Name | PUGH'S PERSONAL CARE HOME
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 5834 ST MATTHEWS ST JOHN CHURCH RD
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City | DONALSONVILLE
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State | GA
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Zip | 39845-3550
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Country | US
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Telephone | 229-524-1015
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Fax | 229-524-1120
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Provider Business Mailing Address
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Address Line | 5834 ST MATTHEW ST JOHN CHURCH RD
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City | DONALSONVILLE
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State | GA
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Zip | 39845
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Country | US
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Telephone | 229-524-1015
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Fax | 229-524-1120
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. BETTY F PUGH
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Credential |
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Telephone | 229-254-0546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | PCH008762
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License Number State | GA
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