SOUTHERN CRESCENT PERSONAL CARE HOME NPI 1639235047

NPI Information

NPI: 1639235047
Provider Name: SOUTHERN CRESCENT PERSONAL CARE HOME
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization
Address:
630 MERIWETHER ST
GRIFFIN, GA
ZIP 30224
Phone: (770) 233-8116
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SOUTHERN CRESCENT PERSONAL CARE HOME is an assisted living facility in Griffin, GA. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. SOUTHERN CRESCENT PERSONAL CARE HOME NPI is 1639235047. The provider is registered as an organization entity type.

The provider's business location address is:

630 MERIWETHER ST
GRIFFIN, GA
ZIP 30224-139
Phone: (770) 233-8116
Fax: (770) 233-8482

The provider's authorized official is Stephanie Odom .
The authorized official title is Ceo and has the following contact phone number (770) 227-9222.

The enumeration date for this NPI number is 12/29/2006 and was last updated on 7/22/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility		031030131	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	040319876A	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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