Provider Demographics
NPI:1407191257
Name:LITCHFIELD HOMES LLC
Entity Type:Organization
Organization Name:LITCHFIELD HOMES LLC
Other - Org Name:ELITR CLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BACCHUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-468-6469
Mailing Address - Street 1:4238 VILLAGE SQUARE LN
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-4270
Mailing Address - Country:US
Mailing Address - Phone:404-248-7945
Mailing Address - Fax:770-679-0617
Practice Address - Street 1:4925 BRIDLE POINT PKWY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-3343
Practice Address - Country:US
Practice Address - Phone:404-248-7945
Practice Address - Fax:770-679-0617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances