Organization
PENISTON PERSONAL CARE HOME,LLC
Active
Other names
Peniston Personal Care Home, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
BREEZY U HOUSTON (OWNER)
(678) 545-3934
Entity
Organization
Contact information
Practice address
4680 SUNDRIDGE TRL, FAIRBURN, GA 30213-1997
(678) 545-3934
(770) 892-1051
Mailing address
4680 SUNDRIDGE TRL, FAIRBURN, GA 30213-1997
(678) 545-3934
(770) 892-1051
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
—
—
251E00000X
Home Health Agency
Primary
—
—
374U00000X
Home Health Aide
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003217267A
—
GA
05
—
003217267B
—
GA
Enumeration date
09/06/2019
Last updated
05/18/2023
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