MEDICARE: ALLEGIANCE 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	311ZA0620X	Adult Care Home Facility		GA

General Provider Information

NPI Number	:	1801146204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEGIANCE PERSONAL CARE HOME

Provider Business Mailing Address
First Line	:	1473 TIMMS CIR SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-3423
Country	:	US
Telephone Number	:	404-246-6606
Fax Number	:	404-601-9919

Provider Business Practice Location Address
First Line	:	1473 TIMMS CIR SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-3423
Country	:	US
Telephone Number	:	404-246-6606
Fax Number	:	404-601-9919

Authorized Official
Title or Position	:	OWNER/ MANAGER
Name	:	MS. GLORIQUA SHANAI HILL
Credential	:
Telephone Number	:	404-246-6606

Provider Enumeration Date	:	09/12/2012
Last Update Date	:	09/12/2012

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