Wonder Years Personal Care Home

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

124269217A Issued in GA

Legal business name

WONDER YEARS PERSONAL CARE HOME

Practice address

3321 Old Salem Rd SE
Conyers, GA 30013-2224

Phone

(773) 354-5040

NPI assigned

Oct 18, 2010

Organization subpart

No

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

Authorized official

Name

Mrs. Angela B Tillman

Title

Owner

Phone

(773) 354-5040

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Wonder Years PCH2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Wonder Years PCH

  • Developmentally Disabled Services Day Training Agency
  • Conyers, GA
  • NPI 1225354624
  NPD tax ID

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

{
    "created_epoch": "1287360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287360000000",
    "number": "1235449893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3321 OLD SALEM RD SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300132224",
            "telephone_number": "773-354-5040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3321 OLD SALEM RD SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300132224",
            "telephone_number": "773-354-5040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WONDER YEARS PERSONAL CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-18",
        "last_updated": "2010-10-18",
        "status": "A",
        "authorized_official_last_name": "TILLMAN",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-354-5040",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "124269217A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124269217A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Gill Witmer, CNM
• William Ernest Wolf, DDS
• Shannon Womack, LPN
• Womens Healthcare and Aesthetics
• Wonder Years PCH
• Patrick Wood, LPC
• Pamela Woodard
• Sherilyn Audrey Woodcome
• Gary E Woodham, PT
• Woodruff Holistic Health Centers, LLC

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Conyers, GA
• Providers in Conyers, GA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.