Provider Demographics
NPI:1538603824
Name:ESSENCE PERSONAL CARE HOME
Entity type:Organization
Organization Name:ESSENCE PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LASHONDA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:SWEDENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-646-5174
Mailing Address - Street 1:206 FLOWING WELLS RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2140
Mailing Address - Country:US
Mailing Address - Phone:803-646-5174
Mailing Address - Fax:
Practice Address - Street 1:206 FLOWING WELLS RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-2140
Practice Address - Country:US
Practice Address - Phone:803-646-5174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCH008654311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care HomeGroup - Single Specialty