Provider Demographics
NPI:1689860256
Name:PHILPOT PERSONAL CARE HOME
Entity Type:Organization
Organization Name:PHILPOT PERSONAL CARE HOME
Other - Org Name:ATLANTA RESIDENTIAL CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-625-1688
Mailing Address - Street 1:4760 CASCADE RD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-7348
Mailing Address - Country:US
Mailing Address - Phone:404-625-1688
Mailing Address - Fax:404-699-9807
Practice Address - Street 1:4760 CASCADE RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-7348
Practice Address - Country:US
Practice Address - Phone:404-625-1688
Practice Address - Fax:404-699-9807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health