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General NPI Number Information
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NPI Number | 1801146204
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Entity Type | Organization
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Legal Business Name | ALLEGIANCE PERSONAL CARE HOME
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 1473 TIMMS CIR SE
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City | ATLANTA
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State | GA
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Zip | 30316-3423
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Country | US
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Telephone | 404-246-6606
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Fax | 404-601-9919
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Provider Business Mailing Address
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Address Line | 1473 TIMMS CIR SE
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City | ATLANTA
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State | GA
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Zip | 30316-3423
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Country | US
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Telephone | 404-246-6606
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Fax | 404-601-9919
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Authorized Official
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Title or Position | OWNER/ MANAGER
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Name | MS. GLORIQUA SHANAI HILL
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Credential |
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Telephone | 404-246-6606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State | GA
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