Organization
PATRON PLACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RONDINE GORDON (OWNER/ADMINISTRATOR)
(770) 573-1076
Entity
Organization
Contact information
Practice address
1227 ROCKBRIDGE RD STE 208-196, STONE MOUNTAIN, GA 30087-3064
(770) 573-1076
(770) 234-5894
Mailing address
1227 ROCKBRIDGE RD STE 208-196, STONE MOUNTAIN, GA 30087-3064
(770) 573-1076
(770) 234-5894
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
PCH006520
GA
311Z00000X
Custodial Care Facility
PCH006520
GA
311ZA0620X
Adult Care Home Facility
PCH006520
GA
Other
Enumeration date
02/07/2012
Last updated
02/07/2012
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