St. Benedict Personal Care Home, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

033012821 Issued in GA

Legal business name

ST. BENEDICT PERSONAL CARE HOME, INC.

Doing business as

ST. BENEDICT PERSONAL CARE HOME

Practice address

1130 Vonda LN SW
Mableton, GA 30126-3024

Phone

(678) 401-4788

Fax

(678) 401-4786

NPI assigned

Aug 18, 2010

Organization subpart

No

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

Authorized official

Name

Mrs. Cassandra Freeman, B.A.

Title

Owner

Phone

(678) 401-4788

Specialties & licenses 1

Addresses

Other names 1

• ST. BENEDICT PERSONAL CARE HOME Doing business as

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

{
    "created_epoch": "1282089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282089600000",
    "number": "1679889307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 VONDA LN SW",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301263024",
            "telephone_number": "678-401-4788",
            "fax_number": "678-401-4786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 VONDA LN SW",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301263024",
            "telephone_number": "678-401-4788",
            "fax_number": "678-401-4786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. BENEDICT PERSONAL CARE HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-18",
        "last_updated": "2010-08-18",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-401-4788",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "B.A."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "GA",
            "license": "033012821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST. BENEDICT PERSONAL CARE HOME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kathy Meredith Smith, DMD
• Social Services Institute, LLC
• Erin Sosebee, PHARM.D.
• Anne-Marie Spearman, P.A.C.
• Keisha Monique Springer, O.T.
• Shakoya Starkey
• Derrick K Staten
• James L Steinhaus, DDS
• Sarah Stern
• Jennifer Makella Stone, D.D.S.

• Assisted Living Facility in Mableton, GA
• Providers in Mableton, 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 Aug 18, 2010; 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.