Organization
RENEE'S PERSONAL CARE HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ISAAC T MILLER (CEO)
(706) 869-0775
Entity
Organization
Contact information
Practice address
1916 OHIO AVE, AUGUSTA, GA 30904-5329
(706) 869-0775
(706) 869-0775
Mailing address
PO BOX 888, EVANS, GA 30809-0888
(706) 869-0775
(706) 869-0775
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
121014201
GA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
121014201
GA
Other
Enumeration date
01/10/2011
Last updated
01/10/2011
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