# ALLGOOD MANOR ASSISTANT HOME INC.

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

## Provider details

- **NPI number:** 1720318843
- **Authorized official:** SOPHIA ANNMARIE DRUMMOND (CEO)
- **Authorized official phone:** (678) 526-9201

## Contact information

- **Practice address:** 6358 DESHONG DR, LITHONIA, GA 30058-6123
- **Practice address phone:** (678) 526-9201
- **Mailing address:** 6358 DESHONG DR, LITHONIA, GA 30058-6123
- **Mailing address phone:** (678) 526-9201

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 315P00000X | Intellectual Disabilities Intermediate Care Facility | 044-01-594-1 | GA | Yes |

## Other

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

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 129286824A | MEDICAID PROVIDER NUMBER | GA |