Provider Demographics
NPI:1336314541
Name:GENTILITY PERSONAL CARE HOME, LLC
Entity Type:Organization
Organization Name:GENTILITY PERSONAL CARE HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NESBITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-977-5134
Mailing Address - Street 1:2803 AUSTIN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-6108
Mailing Address - Country:US
Mailing Address - Phone:678-977-5134
Mailing Address - Fax:678-226-2944
Practice Address - Street 1:2803 AUSTIN RIDGE DR
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-6108
Practice Address - Country:US
Practice Address - Phone:678-977-5134
Practice Address - Fax:678-226-2944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061-01-320-9320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities