Patron Place LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

PCH006520 Issued in GA

Legal business name

PATRON PLACE LLC

Practice address

1227 Rockbridge Rd Ste 208-196
Stone Mountain, GA 30087-3064

Phone

(770) 573-1076

Fax

(770) 234-5894

NPI assigned

Feb 7, 2012

Last updated

Feb 7, 2012By 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

Mrs. Rondine Gordon

Title

Owner/Administrator

Phone

(770) 573-1076

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1328572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328572800000",
    "number": "1457623308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1227 ROCKBRIDGE RD STE 208-196",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873064",
            "telephone_number": "770-573-1076",
            "fax_number": "770-234-5894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1227 ROCKBRIDGE RD STE 208-196",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873064",
            "telephone_number": "770-573-1076",
            "fax_number": "770-234-5894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRON PLACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-07",
        "last_updated": "2012-02-07",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "RONDINE",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "770-573-1076",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "GA",
            "license": "PCH006520",
            "primary": true
        },
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "GA",
            "license": "PCH006520",
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "GA",
            "license": "PCH006520",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Assisted Living Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 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.