Provider Demographics
NPI:1558642157
Name:EDDIES'S CARE HOME INC.
Entity Type:Organization
Organization Name:EDDIES'S CARE HOME INC.
Other - Org Name:LAKE ERMA ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:SALOME
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-269-1043
Mailing Address - Street 1:103 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:GA
Mailing Address - Zip Code:31635-6866
Mailing Address - Country:US
Mailing Address - Phone:229-482-8164
Mailing Address - Fax:229-482-8164
Practice Address - Street 1:103 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:GA
Practice Address - Zip Code:31635-6866
Practice Address - Country:US
Practice Address - Phone:229-482-8164
Practice Address - Fax:229-482-8164
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDDIE'S CARE HOME INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA086020021310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility