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General NPI Number Information
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NPI Number | 1992152490
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Entity Type | Organization
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Legal Business Name | HOME AWAY FROM HOME
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Dates
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Enumeration Date | 05/16/2016
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 5031 GLORE RD SW
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City | MABLETON
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State | GA
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Zip | 30126-5509
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Country | US
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Telephone | 770-289-3682
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Fax | 678-321-1464
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Provider Business Mailing Address
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Address Line | 5031 GLORE RD SW
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City | MABLETON
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State | GA
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Zip | 30126-5509
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Country | US
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Telephone | 770-289-3682
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Fax | 678-321-1464
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Authorized Official
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Title or Position | OWNER
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Name | MRS. VICKIE BURROW-JOHNSON
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Credential |
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Telephone | 770-289-3682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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