# MINERS CREEK PERSONAL CARE HOME

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

## Provider details

- **NPI number:** 1447426093
- **Authorized official:** MS. VIRGINIA MAE THOMPSON (OWNER ADMINISTRATOR)
- **Authorized official phone:** (404) 641-6275

## Contact information

- **Practice address:** 4227 MINERS CREEK RD, LITHONIA, GA 30038-3814
- **Practice address phone:** (404) 641-6275
- **Mailing address:** 5506 STONELEIGH CT, STONE MOUNTAIN, GA 30088-3433
- **Mailing address phone:** (404) 641-6275

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | 044017069 | GA | Yes |

## Other

- **Enumeration date:** 05/04/2008
- **Last updated:** 05/04/2008