Provider Demographics
NPI:1982348215
Name:KNIGHT PERSONAL CARE HOME CENTER
Entity Type:Organization
Organization Name:KNIGHT PERSONAL CARE HOME CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD CARETAKER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ODOM
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-833-6220
Mailing Address - Street 1:2297 WALDEN DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-6514
Mailing Address - Country:US
Mailing Address - Phone:706-833-6220
Mailing Address - Fax:
Practice Address - Street 1:2297 WALDEN DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6514
Practice Address - Country:US
Practice Address - Phone:706-833-6220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility