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Organization

BRYANA PERSONAL CARE HOME

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DIANE CHARLES (CEO)
(404) 454-7155
Entity
Organization

Contact information

Practice address
6276 FIELD GLEN RD, STONE MOUNTAIN, GA 30087-4911
(404) 454-7155
Mailing address
6276 FIELD GLEN RD, STONE MOUNTAIN, GA 30087-4911
(404) 454-7155

Taxonomy

Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
921820039A
MEDICAID PROVIDER NUMBER
GA
Enumeration date
01/12/2010
Last updated
01/12/2010
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