Pine Leaf Personal Care Home
Organization Active NPI Nursing Care Agency · East Dublin, GA
NPI 1235697483 · NPPES record last updated Mar 6, 2019
Key facts
- NPI
- 1235697483
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nursing Care Agency 251J00000X
- Legal business name
- PINE LEAF PERSONAL CARE HOME
- Practice address
- 121 S Elm St
East Dublin, GA 31027-7778 - Phone
- (478) 575-0083
- NPI assigned
- Mar 6, 2019
- Organization subpart
- No
Authorized official
- Name
- Mrs. Shomankia Pinkston Mills
- Title
- Director
- Phone
- (478) 575-0083
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | |||
| Nursing Care Agency | 251J00000X | Yes |
Addresses
Primary practice location
121 S Elm St
East Dublin, GA 31027-7778
Mailing address
121 S Elm St
East Dublin, GA 31027-7778
Phone (478) 575-0083
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3155885 | Medicaid | GA |
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- Paula Smith
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All providers in East Dublin, GA · Nursing Care Agency in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.