Provider Demographics
NPI:1508160045
Name:INTEGRITY PERSONAL CARE HOME
Entity Type:Organization
Organization Name:INTEGRITY PERSONAL CARE HOME
Other - Org Name:INTEGRITY PERSONAL CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKULU EMUOYIBO
Authorized Official - Suffix:
Authorized Official - Credentials:BSC LPN
Authorized Official - Phone:404-957-1991
Mailing Address - Street 1:4192 KENWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-1979
Mailing Address - Country:US
Mailing Address - Phone:404-957-1991
Mailing Address - Fax:404-963-5357
Practice Address - Street 1:4192 KENWOOD TRL
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-1979
Practice Address - Country:US
Practice Address - Phone:404-957-1991
Practice Address - Fax:404-963-5357
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JC GLOBAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-25
Last Update Date:2010-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility