Provider Demographics
NPI:1609235670
Name:DOLLY'S PERSONAL CARE HME
Entity Type:Organization
Organization Name:DOLLY'S PERSONAL CARE HME
Other - Org Name:AGNES TAYLOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-215-6241
Mailing Address - Street 1:38 S BROAD ST
Mailing Address - Street 2:STE 100
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-8000
Mailing Address - Country:US
Mailing Address - Phone:678-559-9009
Mailing Address - Fax:678-261-5928
Practice Address - Street 1:555 COTTON CREEK LN
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-8304
Practice Address - Country:US
Practice Address - Phone:678-559-9009
Practice Address - Fax:678-261-5928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services