Provider Demographics
NPI:1750682571
Name:INTIMATE ESTATES, INC
Entity Type:Organization
Organization Name:INTIMATE ESTATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BELGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-279-5400
Mailing Address - Street 1:449 WOMACK RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-1882
Mailing Address - Country:US
Mailing Address - Phone:678-279-5400
Mailing Address - Fax:678-279-5470
Practice Address - Street 1:449 WOMACK RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-1882
Practice Address - Country:US
Practice Address - Phone:678-279-5400
Practice Address - Fax:678-279-5470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA107030049310400000X, 3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness