Provider Demographics
NPI:1619229416
Name:JASIAH'S PERSONAL CARE HOME
Entity Type:Organization
Organization Name:JASIAH'S PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-638-9444
Mailing Address - Street 1:2323 CRIMSON CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5047
Mailing Address - Country:US
Mailing Address - Phone:678-638-9444
Mailing Address - Fax:
Practice Address - Street 1:2323 CRIMSON CREEK LN
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5047
Practice Address - Country:US
Practice Address - Phone:678-638-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care