Provider Demographics
NPI:1902080831
Name:BELL'S PEACHTREE PERSONAL CARE HOME, LLC
Entity Type:Organization
Organization Name:BELL'S PEACHTREE PERSONAL CARE HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:ANTIONETTE
Authorized Official - Last Name:JOHNSON-GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-552-3560
Mailing Address - Street 1:604 M. L. KING, JR. AVE.
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-2818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:604 M. L. KING, JR. AVE.
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-2818
Practice Address - Country:US
Practice Address - Phone:478-552-3560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility