Organization
FAIRVIEW COMMUNITY PERSONAL CARE HOME, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MONTILIA MAURICE TRIPP (PRESIDENT/CEO)
(678) 570-3149
Entity
Organization
Contact information
Practice address
2470 FAIRVIEW RD SE, CONYERS, GA 30013-4919
(770) 785-7800
(678) 609-1387
Mailing address
2470 FAIRVIEW RD SE, CONYERS, GA 30013-4919
(770) 785-7800
(678) 609-1387
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
107-01-054-1
GA
Other
Enumeration date
02/02/2011
Last updated
02/18/2011
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