Provider Demographics
NPI:1346679180
Name:AD&S PERSONAL CARE HOME, INC.
Entity Type:Organization
Organization Name:AD&S PERSONAL CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-862-1303
Mailing Address - Street 1:3685 SUMMIT TRCE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-3846
Mailing Address - Country:US
Mailing Address - Phone:404-862-1303
Mailing Address - Fax:404-212-1495
Practice Address - Street 1:624 MAXWELL ST
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4213
Practice Address - Country:US
Practice Address - Phone:912-877-5488
Practice Address - Fax:912-877-5464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities