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Organization
SOUTHERN CRESCENT PERSONAL CARE HOME
Active
Organization
SOUTHERN CRESCENT PERSONAL CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE ODOM (CEO)
(770) 227-9222
Entity
Organization
Contact information
Practice address
630 MERIWETHER ST, GRIFFIN, GA 30224-4139
(770) 233-8116
(770) 233-8482
Mailing address
125 HIGHWAY 138 SW, RIVERDALE, GA 30274-4007
(678) 610-4429
(678) 610-4478
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
031030131
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040319876A
—
GA
Enumeration date
12/29/2006
Last updated
07/22/2008
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