Peace Personal Care Home

Primary specialty

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

License

00157470 Issued in GA

Legal business name

PEACE PERSONAL CARE HOME

Practice address

1352 Regal Heights Drive
Lithonia, GA 30058

Phone

(770) 482-8215

Fax

(770) 482-8215

NPI assigned

Feb 5, 2010

Organization subpart

No

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

Authorized official

Name

Ms. Willie Mae Smith

Title

Director/Manager

Phone

(770) 482-8215

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1265328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351123200000",
    "number": "1437481116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1352 REGAL HEIGHTS DR",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300583009",
            "telephone_number": "770-482-8215",
            "fax_number": "770-482-8215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1352 REGAL HEIGHTS DRIVE",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "30058",
            "telephone_number": "770-482-8215",
            "fax_number": "770-482-8215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACE PERSONAL CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-05",
        "last_updated": "2012-10-25",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "DIRECTOR/MANAGER",
        "authorized_official_telephone_number": "770-482-8215",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "00157470",
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "00157470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Lithonia, GA
• Providers in Lithonia, 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 25, 2012; 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.