Provider Demographics
NPI:1316248560
Name:L&R PERSONAL CARE HOME
Entity type:Organization
Organization Name:L&R PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-232-6722
Mailing Address - Street 1:14 SHARPER CIRCLE
Mailing Address - Street 2:L&R PERSONAL CARE HOME
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601
Mailing Address - Country:US
Mailing Address - Phone:229-253-0683
Mailing Address - Fax:
Practice Address - Street 1:14 SHARPER CIRCLE
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GU
Practice Address - Zip Code:31601
Practice Address - Country:US
Practice Address - Phone:229-539-0484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA092-01-112-9320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities