Organization
DADE COMMUNITY LIVING ARRANGEMENT (CLA)
Active
Other names
Dade Personal Care Home (PCH)
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIAN EVADNE WALTERS-MOTT (OWNER/DIRECTOR)
(678) 768-5997
Entity
Organization
Contact information
Practice address
1289 MACEDONIA CHURCH RD., OXFORD, GA 30054-3651
(678) 660-3339
(770) 679-5670
Mailing address
1289 MACEDONIA CHURCH RD., OXFORD, GA 30054-3651
(678) 660-3339
(770) 679-5670
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
GA
376G00000X
Nursing Home Administrator
10701-081-1
GA
376K00000X
Nurse's Aide
CN0028872680
GA
Other
Enumeration date
12/15/2011
Last updated
12/15/2011
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