Organization
ALLGOOD MANOR ASSISTANT HOME INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOPHIA ANNMARIE DRUMMOND (CEO)
(678) 526-9201
Entity
Organization
Contact information
Practice address
6358 DESHONG DR, LITHONIA, GA 30058-6123
(678) 526-9201
Mailing address
6358 DESHONG DR, LITHONIA, GA 30058-6123
(678) 526-9201
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
044-01-594-1
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
129286824A
MEDICAID PROVIDER NUMBER
GA
Enumeration date
01/12/2010
Last updated
01/12/2010
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