Provider Demographics
NPI:1275159386
Name:STILESBORO PERSONAL CARE HOME LLC
Entity Type:Organization
Organization Name:STILESBORO PERSONAL CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARFIELD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOOK
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:678-778-6335
Mailing Address - Street 1:4549 STILESBORO RD NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-3945
Mailing Address - Country:US
Mailing Address - Phone:678-290-0085
Mailing Address - Fax:888-540-0201
Practice Address - Street 1:4549 STILESBORO RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-3945
Practice Address - Country:US
Practice Address - Phone:678-290-0085
Practice Address - Fax:888-540-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care