Provider Demographics
NPI:1093959892
Name:BOBBI PERSONAL CARE HOME INC.
Entity Type:Organization
Organization Name:BOBBI PERSONAL CARE HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BABOUCARR
Authorized Official - Middle Name:O
Authorized Official - Last Name:SENGHORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-438-0138
Mailing Address - Street 1:112 JEFFERSON PKWY
Mailing Address - Street 2:SUITE 714
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-5885
Mailing Address - Country:US
Mailing Address - Phone:404-438-0138
Mailing Address - Fax:
Practice Address - Street 1:112 JEFFERSON PKWY
Practice Address - Street 2:SUITE 714
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-5885
Practice Address - Country:US
Practice Address - Phone:404-438-0138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA639726269AMedicaid