Provider Demographics
NPI:1629339361
Name:DIGNITY CARE HOMES, LLC
Entity Type:Organization
Organization Name:DIGNITY CARE HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:AGEE
Authorized Official - Last Name:BARNWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-629-3267
Mailing Address - Street 1:603 EFFIE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3808
Mailing Address - Country:US
Mailing Address - Phone:678-629-3267
Mailing Address - Fax:
Practice Address - Street 1:603 EFFIE DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3808
Practice Address - Country:US
Practice Address - Phone:678-629-3267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2011015696320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003351727AMedicaid