Provider Demographics
NPI:1316213150
Name:PERSONAL ASSISTANCE OF TOCCOA, LLC
Entity Type:Organization
Organization Name:PERSONAL ASSISTANCE OF TOCCOA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MILISSA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-886-2847
Mailing Address - Street 1:289A BIG A RD
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-6019
Mailing Address - Country:US
Mailing Address - Phone:706-886-2847
Mailing Address - Fax:706-886-0146
Practice Address - Street 1:221 E DOYLE ST
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-2960
Practice Address - Country:US
Practice Address - Phone:706-886-2847
Practice Address - Fax:706-886-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA127-R-0934385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child