Organization
COMFORT ZONE PERSONAL CARE HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARGARET WAIRIMU CLUKEY LPN (DIRECTOR)
(770) 712-9308
Entity
Organization
Contact information
Practice address
485 FROG RD, LOCUST GROVE, GA 30248-3505
(678) 610-5498
(678) 610-5498
Mailing address
301 STONE RD, MCDONOUGH, GA 30253-7267
(770) 712-9308
(678) 610-5498
Taxonomy
Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
CLA001137
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181993856A
—
GA
Enumeration date
09/13/2012
Last updated
09/13/2012
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