Provider Demographics
NPI:1245491844
Name:QUARTERS MANAGING PERSONAL CARE HOME
Entity type:Organization
Organization Name:QUARTERS MANAGING PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAMADOU
Authorized Official - Middle Name:
Authorized Official - Last Name:SYLLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-591-2720
Mailing Address - Street 1:PO BOX 674731
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30006-0003
Mailing Address - Country:US
Mailing Address - Phone:678-591-2720
Mailing Address - Fax:404-812-7821
Practice Address - Street 1:5785 DEERFIELD TRL
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-3763
Practice Address - Country:US
Practice Address - Phone:678-591-2720
Practice Address - Fax:404-812-7821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0600131913104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness