The Mary Washington Assisted Living Home, Inc

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

044018141 Issued in GA

Legal business name

THE MARY WASHINGTON ASSISTED LIVING HOME, INC

Practice address

590 Mountain Oaks Pkwy
Stone Mountain, GA 30087-4732

Phone

(770) 469-0155

Fax

(770) 469-0155

NPI assigned

Nov 12, 2010

Last updated

Nov 12, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Tawana Gray

Title

Ceo

Phone

(770) 469-0155

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1289520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289520000000",
    "number": "1003117615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 MOUNTAIN OAKS PKWY",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300874732",
            "telephone_number": "770-469-0155",
            "fax_number": "770-469-0155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 MOUNTAIN OAKS PKWY",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300874732",
            "telephone_number": "770-469-0155",
            "fax_number": "770-469-0155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MARY WASHINGTON ASSISTED LIVING HOME, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-12",
        "last_updated": "2010-11-12",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "TAWANA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-469-0155",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "GA",
            "license": "044018141",
            "primary": true
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "GA",
            "license": "044018141",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Mental Illness) in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Assisted Living Facility (Mental Illness) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.