INNOVATIVE SOLUTIONS PERSONAL CARE HOME (NPI# 1730621756) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730621756 |
| Entity Type | Organization |
| Organization Name | INNOVATIVE SOLUTIONS PERSONAL CARE HOME |
| Other Organization Name | INNOVATIVE SOLUTIONS PERSONAL CARE HOME |
| Practice Address |
569 Phyllis Cir Camilla GA 31730-6438 |
| Practice Telephone | 2294622055 |
| Mailing Telephone | 2294622055 |
| Enumeration Date | 2016-11-08 |
| Last Update Date | 2016-11-08 |
| Authorized Official Name | TENESHA DENISE GIVENS (OWNER/ADMINISTRATOR) |
| Authorized Official Telephone | 2294622055 |
| Authorized Official Credential | LPN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 320700000X | Residential Treatment Facility, Physical Disabilities | Residential Treatment Facilities | ||
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| INNOVATIVE SOLUTIONS PERSONAL CARE HOME | Doing Business As Name - Organization |
| Street Address |
569 PHYLLIS CIR |
| City | CAMILLA |
| State | GA |
| Zip Code | 31730-6438 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700310059 | Phoebe Primary Care of Camilla | Clinic/Center | 725 Us Highway 19 S, Camilla, GA 31730 | 2017-04-13 |
| 1134661028 | Montreal Biggins Sr. | Counselor | 198 South Mcarthur Drive, Camilla, GA 31730 | 2016-11-09 |
| 1447639307 | Ledora Inman | Counselor | 198 S. Mac Arthur Drive, Camila, GA 31730 | 2015-05-26 |
| 1336533652 | Southern Therapeutic Massage Studio LLC | Massage Therapist | 88 W. Broad St, Camilla, GA 31730 | 2015-03-25 |
| 1013306604 | Jamekah Brooks | Counselor | 198 S Macarthur Drive, Camilla, GA 31730 | 2015-01-20 |
| 1063811651 | Develle Miller | Counselor | 198 S. Macarthur, Camilla, GA 31730 | 2014-08-19 |
| 1679980247 | Amanda Bryant | Counselor | 198 S. Macarthur Dr., Camilla, GA 31730 | 2014-07-16 |
| 1578993945 | Ted Hall | Counselor | 218 S. Mcarthur Drive, Camilla, GA 31730 | 2013-11-20 |
| 1700216280 | Michael D Fowler I | Case Management | 198 S. Macarthur Drive, Camilla, GA 31730 | 2013-11-19 |
| 1750644753 | Sally Niazi | Pharmacist | 266 E Broad Street, Camilla, GA 31730 | 2012-06-25 |
| Find all providers in zip 31730 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790385862 | Hickory Log Vocational School Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3680 Highway 411 Ne, White, GA 30184-2427 | 2020-10-28 |
| 1801403050 | Safe Haven Personal Care Home | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 10875 Abercorn St Apt 132, Savannah, GA 31419-1843 | 2020-09-30 |
| 1659987931 | Pinkies Place | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 216 Self St, Warner Robins, GA 31088-5506 | 2020-09-22 |
| 1629680293 | Caregiver Ga, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3736 Executive Center Dr Ste B, Augusta, GA 30907-2360 | 2020-08-17 |
| 1730799073 | Victory Won Counseling and Res Care Prof. Corp | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5014 Snapfinger Woods Dr, Decatur, GA 30035-4003 | 2020-08-02 |
| 1811528649 | Unison Behavioral Health | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 211 North Street, Douglas, GA 31533 | 2020-01-30 |
| 1619519709 | Gateway Behavioral Health Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 516 Freedom Trl, Brunswick, GA 31525-4712 | 2019-10-10 |
| 1215581756 | Elegant Lm Management, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1020 Meadowsong Circle, Lawrenceville, GA 30043 | 2019-08-01 |
| 1467013821 | Csb of East Central Ga | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5101 Parnell Way, Martinez, GA 30907-8896 | 2019-06-26 |
| 1013474915 | Community Service Board of East Central Georgia | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1715 Lawerence Rd, Hephzibah, GA 30815-4445 | 2019-02-27 |
| 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.