Provider Demographics
NPI:1376978155
Name:EXTON LLC
Entity Type:Organization
Organization Name:EXTON LLC
Other - Org Name:TIARA'S ADULT PERSONAL CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPPING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-369-7355
Mailing Address - Street 1:220 PRICE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-2019
Mailing Address - Country:US
Mailing Address - Phone:770-719-3577
Mailing Address - Fax:678-389-4783
Practice Address - Street 1:220 PRICE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-2019
Practice Address - Country:US
Practice Address - Phone:770-719-3577
Practice Address - Fax:678-389-4783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA05601017-1311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home