Organization
YILLA PERSONAL CARE HOME, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RACQUEL YILLA RN (CEO)
(631) 848-3740
Entity
Organization
Contact information
Practice address
6226 WINDY RIDGE TRL, LITHONIA, GA 30058-6625
(631) 848-3740
(770) 783-6604
Mailing address
6226 WINDY RIDGE TRL, LITHONIA, GA 30058-6625
(631) 848-3740
(770) 783-6604
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
044-01-850-2
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
609202851A
—
GA
05
—
776635011A
—
GA
05
—
776635011B
—
GA
05
—
776635011C
—
GA
05
—
776635011D
—
GA
05
—
776635011E
—
GA
05
—
776635011F
—
GA
05
—
776635011G
—
GA
05
—
776635011H
—
GA
05
—
776635011I
—
GA
Enumeration date
09/14/2010
Last updated
06/02/2012
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