Provider Demographics
NPI:1972265478
Name:E.K.'S PERSONAL CARE HOME, LLC
Entity Type:Organization
Organization Name:E.K.'S PERSONAL CARE HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:EARLEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-491-0078
Mailing Address - Street 1:1865 WALDREP CIR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-4927
Mailing Address - Country:US
Mailing Address - Phone:678-491-0078
Mailing Address - Fax:
Practice Address - Street 1:1865 WALDREP CIR SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-4927
Practice Address - Country:US
Practice Address - Phone:678-491-0078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities