Provider Demographics
NPI:1255620266
Name:HONA'S PERSONAL CARE HOME, INC
Entity type:Organization
Organization Name:HONA'S PERSONAL CARE HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/C.E.O
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-352-8094
Mailing Address - Street 1:6205 ABERCORN ST
Mailing Address - Street 2:102
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5527
Mailing Address - Country:US
Mailing Address - Phone:912-352-8094
Mailing Address - Fax:912-352-8097
Practice Address - Street 1:3213 GRAGG ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-5319
Practice Address - Country:US
Practice Address - Phone:912-354-0179
Practice Address - Fax:912-352-8097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025013261320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA674893944AMedicaid