SAMO HOLDINGS, INC (NPI# 1598055691) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598055691 |
| Entity Type | Organization |
| Organization Name | SAMO HOLDINGS, INC |
| Other Organization Name | AMINA'S HOME |
| Practice Address |
5530 Swanson Rd Ellenwood GA 30294-3857 |
| Mailing Address |
2467 Chauncey Ln Sw Marietta GA 30064-4536 |
| Practice Telephone | 4047292514 |
| Practice Fax Number | 6782645461 |
| Mailing Telephone | 4047292514 |
| Mailing Fax Number | 6782645461 |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2011-04-11 |
| Authorized Official Name | MOSES DEMBA (CEO) |
| Authorized Official Telephone | 4047292514 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 031013109 | GA | Residential Treatment Facilities |
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | 031013109 | GA | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Amina's Home | Other Name - Individual/Organization |
| Street Address |
5530 SWANSON RD |
| City | ELLENWOOD |
| State | GA |
| Zip Code | 30294-3857 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942561717 | Heavenly Angels Home of Care PCh, LLC | Residential Treatment Facility, Physical Disabilities | 5530 Swanson Rd, Ellenwood, GA 30294-3857 | 2012-06-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770124323 | Lula Varist Gholson | Counselor | Christian Counselor Ma Lou Gholson, 549 Lamar Drive, Forest Park, GA 30294 | 2019-10-04 |
| 1609428176 | Tykechia Todd | Ambulance | 3644 Caseys Cove, Ellenwood, GA 30294 | 2019-07-15 |
| 1891285243 | Ayana Aqila Thornton | Nurse Practitioner | 5654 Hosea Court, Ellenwood, GA 30294 | 2018-05-11 |
| 1346748837 | Kakethia S. Mack | Nurse Practitioner | 4124 Bosenberry Way, Ellenwood, GA 30294 | 2018-01-30 |
| 1851819312 | Tatiana Marcus | Prosthetist | 3895 Busby Mill Ct., Ellenwood, GA 30294 | 2017-09-05 |
| 1962944991 | Fairview Urgent Care, LLC | Clinic/Center | 4475 West Village Pkwy, Ellenwood, GA 30294 | 2016-11-08 |
| 1982006169 | Kristal Cure | Licensed Practical Nurse | 4057 Madiosn Court, Ellenwood, GA 30294 | 2014-09-19 |
| 1801233515 | 1st Class Learning and Performing Arts | Local Education Agency (LEA) | 5474 Platte Dr, Ellenwood, GA 30294 | 2013-06-04 |
| 1235480138 | Life Wellness Group of Atlanta | Home Delivered Meals | 145 Wilhemina Drive, Ellenwood, GA 30294 | 2012-10-02 |
| 1346548450 | William K Holley IIi | Counselor | 2732 Holly Berry Dr, Ellenwood, GA 30294 | 2011-03-14 |
| Find all providers in zip 30294 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174823595 | Sid's Place Incorporated | Community Based Residential Treatment Facility, Mental Illness | 2742 Luke Dr, Ellenwood, GA 30294-3987 | 2010-11-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417561747 | Georgia Regional Health LLC | Community Based Residential Treatment Facility, Mental Illness | 1211 Waterville Ct, Alpharetta, GA 30022-5381 | 2020-09-03 |
| 1275161192 | Monte Nido Georgia LLC | Community Based Residential Treatment Facility, Mental Illness | 124 Johnson Ferry Rd Ne, Sandy Springs, GA 30328-3004 | 2020-03-27 |
| 1811464035 | Hope Homes Recovery, LLC | Community Based Residential Treatment Facility, Mental Illness | 432 Virginia Rd, Atlanta, GA 30338-4793 | 2018-10-25 |
| 1770066029 | New Beginnings PCh of Columbus, LLC | Community Based Residential Treatment Facility, Mental Illness | 639 Lawyers Ln, Columbus, GA 31906-3812 | 2018-09-12 |
| 1588140859 | Butterfly Development, LLC | Community Based Residential Treatment Facility, Mental Illness | 1911 Grayson Highway, Suite 8-242, Grayson, GA 30017 | 2018-07-19 |
| 1326555210 | Clayton Center Mhaddd | Community Based Residential Treatment Facility, Mental Illness | 5930 Highway 85 Unit 101, Riverdale, GA 30274-1502 | 2018-01-02 |
| 1245747138 | Clayton Center Mhaddd | Community Based Residential Treatment Facility, Mental Illness | 5930 Highway 85 Unit 104, Riverdale, GA 30274-1502 | 2018-01-02 |
| 1235646217 | Clayton Center Mhaddd | Community Based Residential Treatment Facility, Mental Illness | 5930 Highway 85 Unit 401, Riverdale, GA 30274-1502 | 2017-12-29 |
| 1528574431 | House of Concrete Roses, LLC | Community Based Residential Treatment Facility, Mental Illness | 1133 Huff Rd Nw Apt 766, Atlanta, GA 30318-4327 | 2017-12-15 |
| 1508391756 | Mister Life Coach | Community Based Residential Treatment Facility, Mental Illness | 3681 N Decatur Rd Apt R11, Decatur, GA 30032-1062 | 2017-04-25 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.