Organization
PEACE PERSONAL CARE HOME
Active
Organization
PEACE PERSONAL CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. WILLIE MAE SMITH (DIRECTOR/MANAGER)
(770) 482-8215
Entity
Organization
Contact information
Practice address
1352 REGAL HEIGHTS DRIVE, LITHONIA, GA 30058
(770) 482-8215
(770) 482-8215
Mailing address
1352 REGAL HEIGHTS DR, LITHONIA, GA 30058-3009
(770) 482-8215
(770) 482-8215
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
00157470
GA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
00157470
GA
Other
Enumeration date
02/05/2010
Last updated
10/25/2012
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