Summerfield Personal Care Home LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

SUMMERFIELD PERSONAL CARE HOME LLC

Practice address

12166 Highway 212
Covington, GA 30014-7876

Phone

(678) 600-6704

Fax

(404) 745-8410

NPI assigned

Apr 22, 2024

Organization subpart

No

Name

Brenda Snow Jacobs

Title

Administrator/Provider

Phone

(678) 600-6704

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 4, 2024.

{
    "created_epoch": "1713744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722729600000",
    "number": "1083469092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12166 HIGHWAY 212",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300147876",
            "telephone_number": "678-600-6704",
            "fax_number": "404-745-8410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12166 HIGHWAY 212",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300147876",
            "telephone_number": "678-600-6704",
            "fax_number": "404-745-8410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERFIELD PERSONAL CARE HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-22",
        "last_updated": "2024-08-04",
        "certification_date": "2024-08-04",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "SNOW",
        "authorized_official_title_or_position": "ADMINISTRATOR/PROVIDER",
        "authorized_official_telephone_number": "678-600-6704"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Veronica Khadijah Stroud-McCottrie, NCAC II, CCS, SAM
• Derek M Studer
• Shelly Studer, LCSW
• Avinash Sukhu, PHARMD
• Karen E Sullivan, MD
• Suncrest Home Health of Georgia, Inc.
• Sunshine Psychiatric Consultant Care
• Barbara Lee Anne Susin, C.N.M.
• Johnny M Sutton
• Tiffany Chaffin Swales, MS, ATC, LAT

• All providers in Covington, GA
• Adult Care Home Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2024; 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.