Provider Demographics
NPI:1750598934
Name:HARVEY'S PERSONAL CARE HOME
Entity type:Organization
Organization Name:HARVEY'S PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-285-1525
Mailing Address - Street 1:506 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-6228
Mailing Address - Country:US
Mailing Address - Phone:912-283-3020
Mailing Address - Fax:912-283-3020
Practice Address - Street 1:506 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-6228
Practice Address - Country:US
Practice Address - Phone:912-283-3020
Practice Address - Fax:912-283-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000386310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility