Provider Demographics
NPI:1215347190
Name:JDM ADAMS PERSONAL CARE HOME
Entity type:Organization
Organization Name:JDM ADAMS PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-477-1776
Mailing Address - Street 1:803 MCCULLOUGH RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4901
Mailing Address - Country:US
Mailing Address - Phone:770-210-4236
Mailing Address - Fax:
Practice Address - Street 1:811 MCCULLOUGH RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4901
Practice Address - Country:US
Practice Address - Phone:770-477-1776
Practice Address - Fax:770-477-1776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA385H00000X385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care