Provider Demographics
NPI:1851443568
Name:EASY LIVING PERSONAL CARE HOME
Entity Type:Organization
Organization Name:EASY LIVING PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-886-4454
Mailing Address - Street 1:2688 FOREST HILLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-9747
Mailing Address - Country:US
Mailing Address - Phone:706-886-4454
Mailing Address - Fax:706-886-1670
Practice Address - Street 1:2688 FOREST HILLS DRIVE
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-9747
Practice Address - Country:US
Practice Address - Phone:706-886-4454
Practice Address - Fax:706-886-1670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility