Provider Demographics
NPI:1023467545
Name:NORTH GEORGIA PERSONAL CARE LLC
Entity type:Organization
Organization Name:NORTH GEORGIA PERSONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-253-0131
Mailing Address - Street 1:501 NORTH MAIN ST.
Mailing Address - Street 2:SUITE B
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143
Mailing Address - Country:US
Mailing Address - Phone:706-253-0131
Mailing Address - Fax:706-253-0131
Practice Address - Street 1:501 NORTH MAIN ST.
Practice Address - Street 2:SUITE B
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143
Practice Address - Country:US
Practice Address - Phone:706-253-0131
Practice Address - Fax:706-253-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA112-R-0521251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003112151AMedicaid
GA003112151BOtherSOURSE