# MADEAR'S PLACE PERSONAL CARE HOME LLC

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

## Provider details

- **NPI number:** 1568342731
- **Authorized official:** THERESA PATTERSON (OWNER)
- **Authorized official phone:** (229) 269-6039

## Contact information

- **Practice address:** 4664 VIENNA CHURCH RD, VALDOSTA, GA 31605-5524
- **Practice address phone:** (229) 234-2734
- **Mailing address:** 4664 VIENNA CHURCH RD, VALDOSTA, GA 31605-5524
- **Mailing address phone:** (229) 234-2734

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3104A0625X | Assisted Living Facility (Mental Illness) | — | NULL | — |
| 3104A0630X | Assisted Living Facility (Behavioral Disturbances) | — | NULL | — |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 09/06/2025
- **Last updated:** 09/06/2025