Provider Demographics
NPI:1902022429
Name:MORELAND PERSONAL CARE HOME INC.
Entity Type:Organization
Organization Name:MORELAND PERSONAL CARE HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:FRANCINE
Authorized Official - Last Name:MORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-222-1774
Mailing Address - Street 1:2670 OWENS AVE SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4266
Mailing Address - Country:US
Mailing Address - Phone:770-222-1774
Mailing Address - Fax:770-222-0814
Practice Address - Street 1:2670 OWENS AVE SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4266
Practice Address - Country:US
Practice Address - Phone:770-222-1774
Practice Address - Fax:678-921-9571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00938033AMedicaid