SID'S PLACE INCORPORATED NPI 1174823595

NPI Information

  • NPI: 1174823595
  • Provider Name: SID'S PLACE INCORPORATED
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Organization
  • Address: 2742 LUKE DR
    ELLENWOOD, GA
    ZIP 30294
  • Phone: (678) 557-8969

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NPI Details

SID'S PLACE INCORPORATED is an assisted living facility in Ellenwood, 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. SID'S PLACE INCORPORATED NPI is 1174823595. The provider is registered as an organization entity type.

The provider's business location address is:

2742 LUKE DR
ELLENWOOD, GA
ZIP 30294-987
Phone: (678) 557-8969
Fax: (404) 521-4888

The provider's authorized official is Zannie Darrell Black .
The authorized official title is Owner and has the following contact phone number (678) 557-8969.

The enumeration date for this NPI number is 11/1/2010 and was last updated on 11/1/2010.

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
1320800000XCommunity Based Residential Treatment Facility, Mental Illness031012928GEORGIANo
2310400000XAssisted Living Facility031012928GEORGIAYes

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
1992605365AMEDICAIDGEORGIA

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: 11/21/2025

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