Provider Demographics
NPI:1407158231
Name:MCKNIGHT PERSONAL CARE HOME INC,
Entity Type:Organization
Organization Name:MCKNIGHT PERSONAL CARE HOME INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANTERIA
Authorized Official - Middle Name:LASHUN
Authorized Official - Last Name:MCKNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-643-3600
Mailing Address - Street 1:3045 CARRIAGE TRL
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-6835
Mailing Address - Country:US
Mailing Address - Phone:678-519-2115
Mailing Address - Fax:678-216-0311
Practice Address - Street 1:3045 CARRIAGE TRL
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-6835
Practice Address - Country:US
Practice Address - Phone:678-519-2115
Practice Address - Fax:678-216-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility