# BRYANA PERSONAL CARE HOME

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

## Provider details

- **NPI number:** 1275863383
- **Authorized official:** DIANE CHARLES (CEO)
- **Authorized official phone:** (404) 454-7155

## Contact information

- **Practice address:** 6276 FIELD GLEN RD, STONE MOUNTAIN, GA 30087-4911
- **Practice address phone:** (404) 454-7155
- **Mailing address:** 6276 FIELD GLEN RD, STONE MOUNTAIN, GA 30087-4911
- **Mailing address phone:** (404) 454-7155

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 315P00000X | Intellectual Disabilities Intermediate Care Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 01/12/2010
- **Last updated:** 01/12/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 921820039A | MEDICAID PROVIDER NUMBER | GA |