Organization
CROWN PERSONAL CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EMMANUEL OSO (OWNER)
(678) 216-1618
Entity
Organization
Contact information
Practice address
891 STORMY LN, JONESBORO, GA 30238-5984
(678) 216-1618
Mailing address
891 STORMY LN, JONESBORO, GA 30238-5984
(678) 216-1618
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
031-01-246-1
GA
Other
Enumeration date
12/13/2010
Last updated
12/13/2010
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