Provider Demographics
NPI:1235369513
Name:CHOICE PERSONAL CARE HOME
Entity Type:Organization
Organization Name:CHOICE PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-477-6536
Mailing Address - Street 1:3850 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3632
Mailing Address - Country:US
Mailing Address - Phone:424-477-6536
Mailing Address - Fax:770-969-5958
Practice Address - Street 1:1030 SCOTT RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-1558
Practice Address - Country:US
Practice Address - Phone:424-477-6536
Practice Address - Fax:770-969-5958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home