MEDICARE: CARTERSVILLE PERSONAL CARE HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311Z00000X	Custodial Care Facility		GA

General Provider Information

NPI Number	:	1407386204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARTERSVILLE PERSONAL CARE HOME

Provider Business Mailing Address
First Line	:	5 BOWEN CT
Second Line	:
City	:	CARTERSVILLE
State	:	GA
Zip	:	30120-2493
Country	:	US
Telephone Number	:	678-605-9339
Fax Number	:	678-605-9340

Provider Business Practice Location Address
First Line	:	5 BOWEN CT
Second Line	:
City	:	CARTERSVILLE
State	:	GA
Zip	:	30120-2493
Country	:	US
Telephone Number	:	678-605-9339
Fax Number	:	678-605-9340

Authorized Official
Title or Position	:	CORPORATE ADMINISTRATIVE ASSISTANT
Name	:	ANNA COTTON
Credential	:
Telephone Number	:	770-692-3875

Provider Enumeration Date	:	06/14/2017
Last Update Date	:	07/21/2022

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Directions to “CARTERSVILLE PERSONAL CARE HOME ” Practice Location

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