Provider Demographics
NPI:1538438809
Name:NELL'S PERSONAL CARE HOME, LLC
Entity type:Organization
Organization Name:NELL'S PERSONAL CARE HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:L
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-471-2287
Mailing Address - Street 1:8990 STERLING RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-4659
Mailing Address - Country:US
Mailing Address - Phone:770-471-2287
Mailing Address - Fax:770-471-6622
Practice Address - Street 1:8990 STERLING RIDGE LN
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-4659
Practice Address - Country:US
Practice Address - Phone:770-471-2287
Practice Address - Fax:770-471-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031012541320700000X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities