Organization
PINE LEAF PERSONAL CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHOMANKIA PINKSTON MILLS (DIRECTOR)
(478) 575-0083
Entity
Organization
Contact information
Practice address
121 S ELM ST, EAST DUBLIN, GA 31027-7778
(478) 575-0083
Mailing address
121 S ELM ST, EAST DUBLIN, GA 31027-7778
(478) 575-0083
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3155885
—
GA
Enumeration date
03/06/2019
Last updated
03/06/2019
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