# NELL'S PERSONAL CARE HOME, LLC

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

## Provider details

- **NPI number:** 1538438809
- **Authorized official:** MR. CLIFFORD L. JACKSON (CEO)
- **Authorized official phone:** (770) 471-2287

## Contact information

- **Practice address:** 8990 STERLING RIDGE LN, JONESBORO, GA 30238-4659
- **Practice address phone:** (770) 471-2287
- **Practice address fax:** (770) 471-6622
- **Mailing address:** 8990 STERLING RIDGE LN, JONESBORO, GA 30238-4659
- **Mailing address phone:** (770) 471-2287
- **Mailing address fax:** (770) 471-6622

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 031012541 | GA | Yes |
| 320700000X | Physical Disabilities Residential Treatment Facility | 031012541 | GA | — |

## Other

- **Enumeration date:** 12/15/2011
- **Last updated:** 12/15/2011