Provider Demographics
NPI:1295037877
Name:S&Y PERSONAL CARE HOME
Entity Type:Organization
Organization Name:S&Y PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:706-975-4590
Mailing Address - Street 1:615 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3580
Mailing Address - Country:US
Mailing Address - Phone:706-647-9389
Mailing Address - Fax:706-647-9389
Practice Address - Street 1:615 W MAIN ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3580
Practice Address - Country:US
Practice Address - Phone:706-647-9389
Practice Address - Fax:706-647-9389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA145-01-013-9261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health