Fairview Community Personal Care Home, Inc.

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

107-01-054-1 Issued in GA

Legal business name

FAIRVIEW COMMUNITY PERSONAL CARE HOME, INC.

Practice address

2470 Fairview Rd SE
Conyers, GA 30013-4919

Phone

(770) 785-7800

Fax

(678) 609-1387

NPI assigned

Feb 2, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Montilia Maurice Tripp

Title

President/Ceo

Phone

(678) 570-3149

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1296604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297987200000",
    "number": "1477859841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2470 FAIRVIEW RD SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300134919",
            "telephone_number": "770-785-7800",
            "fax_number": "678-609-1387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2470 FAIRVIEW RD SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300134919",
            "telephone_number": "770-785-7800",
            "fax_number": "678-609-1387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRVIEW COMMUNITY PERSONAL CARE HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-02",
        "last_updated": "2011-02-18",
        "status": "A",
        "authorized_official_last_name": "TRIPP",
        "authorized_official_first_name": "MONTILIA",
        "authorized_official_middle_name": "MAURICE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "678-570-3149",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "GA",
            "license": "107-01-054-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Mental Illness) in Conyers, GA
• Providers in Conyers, GA by specialty
• Assisted Living Facility (Mental Illness) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2011; 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.