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General NPI Number Information
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NPI Number | 1790174944
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Entity Type | Organization
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Legal Business Name | RISING STAR PERSONAL CARE HOME LLC
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 5018 E PONCE DE LEON AVE
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-1236
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Country | US
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Telephone | 404-298-0150
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Fax | 678-904-5628
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Provider Business Mailing Address
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Address Line | 5018 E PONCE DE LEON AVE
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-1236
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Country | US
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Telephone | 404-298-0150
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Fax | 678-904-5628
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | TERRIE LISA MCGILL
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Credential |
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Telephone | 678-701-5115
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | PCH009075
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License Number State | GA
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