Organization
INNOVATIVE SOLUTIONS PERSONAL CARE HOME
Active
Other names
INNOVATIVE SOLUTIONS PERSONAL CARE HOME
Organization subpart
No
Provider details
NPI number
Authorized official
TENESHA DENISE GIVENS LPN (OWNER/ADMINISTRATOR)
(229) 462-2055
Entity
Organization
Contact information
Practice address
569 PHYLLIS CIR, CAMILLA, GA 31730-6438
(229) 462-2055
Mailing address
569 PHYLLIS CIR, CAMILLA, GA 31730-6438
(229) 462-2055
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/08/2016
Last updated
11/08/2016
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