THE MARY WASHINGTON ASSISTED LIVING HOME, INC (NPI# 1003117615) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003117615 |
| Entity Type | Organization |
| Organization Name | THE MARY WASHINGTON ASSISTED LIVING HOME, INC |
| Practice Address |
590 Mountain Oaks Pkwy Stone Mountain GA 30087-4732 |
| Practice Telephone | 7704690155 |
| Practice Fax Number | 7704690155 |
| Mailing Telephone | 7704690155 |
| Mailing Fax Number | 7704690155 |
| Enumeration Date | 2010-11-12 |
| Last Update Date | 2010-11-12 |
| Authorized Official Name | MS. TAWANA GRAY (CEO) |
| Authorized Official Telephone | 7704690155 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3104A0630X |
Assisted Living Facility Specialization: Assisted Living, Behavioral Disturbances |
044018141 | GA | Nursing & Custodial Care Facilities |
| Y | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
044018141 | GA | Nursing & Custodial Care Facilities |
| Street Address |
590 MOUNTAIN OAKS PKWY |
| City | STONE MOUNTAIN |
| State | GA |
| Zip Code | 30087-4732 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477176394 | Optimal Choice Telehealth | General Practice | 1227 Rockbidge Rd Sw, Ste 208-354, Stone Mountain, GA 30087 | 2020-05-27 |
| 1245882943 | Lynell Williams | Counselor | 505 Lilburn-stone Mountain Road, Suite 235, Stone Mountain, GA 30087 | 2019-07-12 |
| 1003302688 | Mark Andrew Stevens | Physical Therapist | 1227 Rockbridge Rd Ste 402, Stone Mountain, GA 30087 | 2018-07-06 |
| 1154816825 | Tuan Minh Khong | Physician Assistant | 6301 Southland Rdg, Stone Mountain, GA 30087 | 2018-06-26 |
| 1215429881 | Stephanie Martin | Nurse Practitioner | 2720 S Rockbridge Rd, Stone Mountain, GA 30087 | 2018-05-30 |
| 1578979381 | Edmund Thomas Jr. | Dentist | 2536 Rockbridge Rd Ste 103, Stone Mountain, GA 30087 | 2014-07-02 |
| 1790027688 | Robert Fanning Eaves Jr. | General Practice | 5394 Leatherstocking Lane, Stone Mountain, GA 30087 | 2013-03-19 |
| 1609128917 | Mary Marlene Muse | Lactation Consultant, Non-RN | 510 Navarre Drive, Stone Mountain, GA 30087 | 2012-10-10 |
| 1457680704 | Cleo Evans | Counselor | 5638 Manassas Run, Stone Mountain, GA 30087 | 2009-12-16 |
| 1932348521 | Lawrence Randy Sheber | Dentist | 5500-a Lilburn Stone Mountain Road, Stone Mountain, GA 30087 | 2009-02-05 |
| Find all providers in zip 30087 | ||||
| Taxonomy Code | 3104A0625X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Mental Illness |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083215842 | Stewart Community Home, Inc. | Assisted Living Facility | 1125 15th St, Columbus, GA 31901-2219 | 2020-11-06 |
| 1952851602 | Gates Health Care Services, LLC | Assisted Living Facility | 400 Wallace Cir, Bloomingdale, GA 31302-8050 | 2016-10-06 |
| 1801251202 | Prime Veritas | Assisted Living Facility | 1889 Trinity Mill Dr, Dacula, GA 30019-1015 | 2015-12-30 |
| 1053730267 | Hooks Home of Care | Assisted Living Facility | 4466 Pinedale Dr, Macon, GA 31206-4530 | 2014-04-15 |
| 1699024141 | Transitional Hope Unlimited | Assisted Living Facility | 4 Harvey St Ne, Rome, GA 30161-5122 | 2012-08-30 |
| 1164782223 | Sweet Pea Personal Care Home | Assisted Living Facility | 9387 Burkhalter Rd, Statesboro, GA 30461-6765 | 2012-05-23 |
| 1447532007 | Pendley Personal Care Home Inc. | Assisted Living Facility | 2548 Central Ave, Augusta, GA 30904-6240 | 2011-09-09 |
| 1215216445 | Paula's Safe House | Assisted Living Facility | 3900 Rockey Valley Dr, Conley, GA 30288-1410 | 2011-08-04 |
| 1174819619 | Prn Nursing and Alternative Living Family Care Solutions | Assisted Living Facility | 115 Lakeshore Dr S, Ivey, GA 31031-3537 | 2011-06-23 |
| 1477859841 | Fairview Community Personal Care Home, Inc. | Assisted Living Facility | 2470 Fairview Rd Se, Conyers, GA 30013-4919 | 2011-02-02 |
| Find all providers with the same taxonomy | ||||
| City | STONE MOUNTAIN |
| Zip Code | 30087 |
Please comment or provide details below to improve the information on THE MARY WASHINGTON ASSISTED LIVING HOME, INC.
| 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.