Organization
BRYANA PERSONAL CARE HOME, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE CHARLES (CEO)
(404) 454-7155
Entity
Organization
Contact information
Practice address
6276 FIELD GLEN RD, STONE MOUNTAIN, GA 30087-4911
(678) 587-5543
(678) 587-5543
Mailing address
6276 FIELD GLEN RD, STONE MOUNTAIN, GA 30087-4911
(678) 587-5543
(678) 587-5543
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
044-01-357-2
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
921820039A
—
GA
05
—
921820039D
—
GA
Enumeration date
08/09/2013
Last updated
08/09/2013
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