# DRD PRIVATE HOME CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023823960
- **Authorized official:** DE'SHALAH POTTER (MANAGER)
- **Authorized official phone:** (470) 412-0295

## Contact information

- **Practice address:** 7712 AUTRY CIR APT 310, DOUGLASVILLE, GA 30134-5730
- **Practice address phone:** (470) 276-4515
- **Practice address fax:** (470) 228-5106
- **Mailing address:** 7712 AUTRY CIR APT 310, DOUGLASVILLE, GA 30134-5730
- **Mailing address phone:** (470) 276-4515
- **Mailing address fax:** (470) 228-5106

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | — | Yes |
| 385HR2055X | Child Mental Illness Respite Care | — | — | — |
| 385HR2060X | Child Intellectual and/or Developmental Disabilities Respite Care | — | — | — |
| 385HR2065X | Child Physical Disabilities Respite Care | — | — | — |

## Other

- **Enumeration date:** 02/10/2025
- **Last updated:** 05/19/2025