Provider Demographics
NPI:1508546961
Name:POSITIVE CARE PERSONAL CARE HOME, INC
Entity Type:Organization
Organization Name:POSITIVE CARE PERSONAL CARE HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-467-1087
Mailing Address - Street 1:212 WILLIS DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7272
Mailing Address - Country:US
Mailing Address - Phone:770-507-0123
Mailing Address - Fax:770-507-7021
Practice Address - Street 1:212 WILLIS DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7272
Practice Address - Country:US
Practice Address - Phone:770-507-0123
Practice Address - Fax:770-507-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health