Organization
MASALON PERSONAL CARE HOME INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAKESA MAMIE FOFANA (OWNER)
(917) 826-4317
Entity
Organization
Contact information
Practice address
3952 ROCKBRIDGE RD, STONE MOUNTAIN, GA 30083-4170
(917) 826-4317
Mailing address
3952 ROCKBRIDGE RD, STONE MOUNTAIN, GA 30083-4170
(917) 826-4317
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
3747P1801X
Personal Care Attendant
—
—
Other
Enumeration date
05/13/2020
Last updated
05/13/2020
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