Provider Demographics
NPI:1851601512
Name:NYLA'S PERSONAL CARE HOME, INC
Entity Type:Organization
Organization Name:NYLA'S PERSONAL CARE HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-291-5975
Mailing Address - Street 1:2417 GARDEN LAKES BLVD NW STE C
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1159
Mailing Address - Country:US
Mailing Address - Phone:706-291-5975
Mailing Address - Fax:706-291-5976
Practice Address - Street 1:2417 GARDEN LAKES BLVD NW STE C
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1159
Practice Address - Country:US
Practice Address - Phone:706-291-5975
Practice Address - Fax:706-291-5976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health