Provider Demographics
NPI:1487842282
Name:A UNIQUE PERSONAL CARE HOME,INC.
Entity Type:Organization
Organization Name:A UNIQUE PERSONAL CARE HOME,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LECOUNTE
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:ORS
Authorized Official - Phone:678-595-4938
Mailing Address - Street 1:4127 KINGSHIP DR
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-4211
Mailing Address - Country:US
Mailing Address - Phone:404-212-0057
Mailing Address - Fax:770-679-4437
Practice Address - Street 1:1517 BORDEAUX LN
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-1109
Practice Address - Country:US
Practice Address - Phone:770-679-4437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-07
Last Update Date:2007-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility