New Domus Personal Care, LLC

Primary specialty

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

License

060-01-256-2 Issued in GA

Legal business name

NEW DOMUS PERSONAL CARE, LLC

Practice address

2650 Colonial Dr
College Park, GA 30337-4923

Phone

(404) 209-9296

NPI assigned

Jul 4, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Jackie Othella Smith Jr.

Title

Ceo

Phone

(770) 996-6588

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1183507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472169600000",
    "number": "1639377385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6229 JOHNSON RD",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302741806",
            "telephone_number": "770-996-6588",
            "fax_number": "770-997-8240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 COLONIAL DR",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303374923",
            "telephone_number": "404-209-9296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW DOMUS PERSONAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-04",
        "last_updated": "2016-08-26",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_middle_name": "OTHELLA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-996-6588",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "060-01-256-2",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112615323A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda L Myree, M.T.
• Nak Union, Inc
• National Medical Enterprise
• Chedrick Neal
• Neighborhood Wellness LLC
• New Era Medical Equipment and Supplies
• Andrew James Newsome, DDS, PC, MAGD
• Nextgen EMS LLC
• Son Thanh Nguyen, M.D.
• Nky Housing and Homecare Services LLC

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in College Park, GA
• Providers in College Park, 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 Aug 26, 2016; 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.