Organization
THE HOMEPLACE SHELTER INC.
Active
Parent organization
THE HOMEPLACE SHELTER INC.
Other names
Mildred's HomePlace III
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE HOMEPLACE SHELTER INC.
Authorized official
MR. NANCY LEE MITCHELL (ADMINISTRATOR)
(229) 228-1985
Entity
Organization
Contact information
Practice address
612 E CLAY ST, THOMASVILLE, GA 31792-4608
(229) 551-0695
(229) 551-0694
Mailing address
612 E CLAY ST, 610 EAST CLAY STREET, THOMASVILLE, GA 31792-4608
(229) 551-0695
(229) 551-0694
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
136-01-096-1
GA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
136-01-096-1
GA
347C00000X
Private Vehicle
136-01-096-1
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136-01-096-1
PERSONAL CARE HOME
GA
Enumeration date
08/26/2009
Last updated
08/26/2009
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