Provider Demographics
NPI:1508094855
Name:AZARIA PERSONAL CARE HOME LLC
Entity Type:Organization
Organization Name:AZARIA PERSONAL CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STELUTA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERTEA
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:770-682-3753
Mailing Address - Street 1:1753 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-3264
Mailing Address - Country:US
Mailing Address - Phone:770-682-3753
Mailing Address - Fax:
Practice Address - Street 1:1753 AZALEA DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-3264
Practice Address - Country:US
Practice Address - Phone:770-682-3753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067013581311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home