Provider Demographics
NPI:1801146204
Name:ALLEGIANCE PERSONAL CARE HOME
Entity type:Organization
Organization Name:ALLEGIANCE PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIQUA
Authorized Official - Middle Name:SHANAI
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-246-6606
Mailing Address - Street 1:1473 TIMMS CIR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-3423
Mailing Address - Country:US
Mailing Address - Phone:404-246-6606
Mailing Address - Fax:404-601-9919
Practice Address - Street 1:1473 TIMMS CIR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-3423
Practice Address - Country:US
Practice Address - Phone:404-246-6606
Practice Address - Fax:404-601-9919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home