Provider Demographics
NPI:1558126359
Name:SILLAH GROUP HOME, INC
Entity Type:Organization
Organization Name:SILLAH GROUP HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ANGELLA
Authorized Official - Last Name:PEART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-517-6905
Mailing Address - Street 1:3296 HIGHPOINT CT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-7401
Mailing Address - Country:US
Mailing Address - Phone:719-517-6905
Mailing Address - Fax:
Practice Address - Street 1:14 WALL STREET
Practice Address - Street 2:NEW YORK
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005
Practice Address - Country:US
Practice Address - Phone:719-517-6905
Practice Address - Fax:585-502-1157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No253Z00000XAgenciesIn Home Supportive Care
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities