Provider Demographics
NPI:1740404037
Name:BUTLER-BOWDEN PERSONAL CARE HOME, INC
Entity Type:Organization
Organization Name:BUTLER-BOWDEN PERSONAL CARE HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-498-6381
Mailing Address - Street 1:694 LEIGHTON WAY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-1829
Mailing Address - Country:US
Mailing Address - Phone:770-498-6381
Mailing Address - Fax:770-413-9447
Practice Address - Street 1:694 LEIGHTON WAY
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-1829
Practice Address - Country:US
Practice Address - Phone:770-498-6381
Practice Address - Fax:770-413-9447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-01-294-2315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000917056AMedicaid
GA000917056BMedicaid