Provider Demographics
NPI:1922868579
Name:S & S PERSONAL CARE HOME, LLC
Entity type:Organization
Organization Name:S & S PERSONAL CARE HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-343-0391
Mailing Address - Street 1:475 CINDERELLA LN SE
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:GA
Mailing Address - Zip Code:39842-1850
Mailing Address - Country:US
Mailing Address - Phone:229-695-9075
Mailing Address - Fax:229-329-4474
Practice Address - Street 1:475 CINDERELLA LN SE
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:GA
Practice Address - Zip Code:39842-1850
Practice Address - Country:US
Practice Address - Phone:229-695-9075
Practice Address - Fax:229-329-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility