# PENISTON PERSONAL CARE HOME,LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Peniston Personal Care Home, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003465626
- **Authorized official:** BREEZY U HOUSTON (OWNER)
- **Authorized official phone:** (678) 545-3934

## Contact information

- **Practice address:** 4680 SUNDRIDGE TRL, FAIRBURN, GA 30213-1997
- **Practice address phone:** (678) 545-3934
- **Practice address fax:** (770) 892-1051
- **Mailing address:** 4680 SUNDRIDGE TRL, FAIRBURN, GA 30213-1997
- **Mailing address phone:** (678) 545-3934
- **Mailing address fax:** (770) 892-1051

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WH0200X | Home Health Registered Nurse | — | NULL | — |
| 163WH0200X | Home Health Registered Nurse | — | — | — |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 374U00000X | Home Health Aide | — | NULL | — |
| 374U00000X | Home Health Aide | — | — | — |

## Other

- **Enumeration date:** 09/06/2019
- **Last updated:** 05/18/2023