Provider Demographics
NPI:1801183892
Name:CHELSEA PERSONAL CARE HOME, LLC
Entity Type:Organization
Organization Name:CHELSEA PERSONAL CARE HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:THIOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-370-4144
Mailing Address - Street 1:2045 MOUNT ZION RD
Mailing Address - Street 2:#357
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-3313
Mailing Address - Country:US
Mailing Address - Phone:404-370-4144
Mailing Address - Fax:404-745-0239
Practice Address - Street 1:2333 BROOKGATE WAY
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-2398
Practice Address - Country:US
Practice Address - Phone:404-370-4144
Practice Address - Fax:404-745-0239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCH008063320600000X, 320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities