Provider Demographics
NPI:1083263545
Name:TEMPLE PERSONAL CARE HOME LLC
Entity Type:Organization
Organization Name:TEMPLE PERSONAL CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE GERTRUDE
Authorized Official - Middle Name:BITOTA
Authorized Official - Last Name:TSHIMANGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-660-1571
Mailing Address - Street 1:838 SHADYBROOK DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6215
Mailing Address - Country:US
Mailing Address - Phone:404-660-1571
Mailing Address - Fax:
Practice Address - Street 1:838 SHADYBROOK DR NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-6215
Practice Address - Country:US
Practice Address - Phone:404-660-1571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty