Provider Demographics
NPI:1437489762
Name:NORTH GEORGIA PERSONAL CARE LLC
Entity Type:Organization
Organization Name:NORTH GEORGIA PERSONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:(706)0253-0131
Authorized Official - Phone:706-253-0131
Mailing Address - Street 1:80 LARKSUPR LANE
Mailing Address - Street 2:
Mailing Address - City:TALKING ROCK
Mailing Address - State:GA
Mailing Address - Zip Code:30175
Mailing Address - Country:US
Mailing Address - Phone:706-253-0131
Mailing Address - Fax:706-253-0131
Practice Address - Street 1:80 LARKSPUR LN
Practice Address - Street 2:80 LARKSPUR LANE
Practice Address - City:TALKING ROCK
Practice Address - State:GA
Practice Address - Zip Code:30175-3743
Practice Address - Country:US
Practice Address - Phone:706-253-0131
Practice Address - Fax:706-253-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA112-R-0521311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home