Provider Demographics
NPI:1104041367
Name:WATKINS PERSONAL CARE HOMES, INC.
Entity Type:Organization
Organization Name:WATKINS PERSONAL CARE HOMES, INC.
Other - Org Name:ISAACS HAVEN ASSISTED LIVING & VIRGINIA GARDENS ASSISTED LIVING
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:ROLLAND
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:478-676-4646
Mailing Address - Street 1:PO BOX 1322
Mailing Address - Street 2:1939 ISAAC WATKINS ROAD
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-1322
Mailing Address - Country:US
Mailing Address - Phone:478-676-4646
Mailing Address - Fax:478-676-4634
Practice Address - Street 1:1939 ISAAC WATKINS RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:GA
Practice Address - Zip Code:31065-3307
Practice Address - Country:US
Practice Address - Phone:478-676-3437
Practice Address - Fax:478-825-3062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA310400000X, 310400000X, 3104A0625X, 3104A0625X, 3104A0630X, 3104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Not Answered3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances