Nell'S Personal Care Home, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

031012541 Issued in GA

Legal business name

NELL'S PERSONAL CARE HOME, LLC

Practice address

8990 Sterling Ridge LN
Jonesboro, GA 30238-4659

Phone

(770) 471-2287

Fax

(770) 471-6622

NPI assigned

Dec 15, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Clifford L. Jackson

Title

Ceo

Phone

(770) 471-2287

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1323907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323907200000",
    "number": "1538438809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8990 STERLING RIDGE LN",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302384659",
            "telephone_number": "770-471-2287",
            "fax_number": "770-471-6622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8990 STERLING RIDGE LN",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302384659",
            "telephone_number": "770-471-2287",
            "fax_number": "770-471-6622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NELL'S PERSONAL CARE HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-15",
        "last_updated": "2011-12-15",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "CLIFFORD",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-471-2287",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "031012541",
            "primary": true
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "GA",
            "license": "031012541",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.