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SID'S PLACE INCORPORATED
NPI 1174823595
Assisted Living Facility in Ellenwood, GA

Active since November 01, 2010
2742 LUKE DR, ELLENWOOD, GA 30294(678) 557-8969(404) 521-4888 Get Directions Write a Review

NPPES record last updated: November 1, 2010. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Sid's Place Incorporated NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SID'S PLACE INCORPORATED (NPI 1174823595) is a healthcare organization registered as an assisted living facility in Ellenwood, Georgia and active in the NPI registry since November 2010. The organization lists Zannie Darrell Black, Owner, as its authorized official.

NPPES Registry Identity

NPI1174823595
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameSID'S PLACE INCORPORATED
Location Address2742 LUKE DREllenwood, GA 30294-3987
Mailing Address2742 Luke DrEllenwood, GA 30294-3987 · (678) 557-8969 · Fax (404) 521-4888
Phone(678) 557-8969
Fax(404) 521-4888
Organization SubpartNo
Authorized OfficialZannie Darrell BlackOwner · (678) 557-8969
Enumeration DateNovember 1, 2010
✔ NPI 1174823595 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in GA · 031012928
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
Also ListedCommunity Based Residential Treatment Facility, Mental IllnessTaxonomy 320800000X · License 031012928 (GA)
2742 LUKE DR, Ellenwood, GA 30294
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Other Identifiers 1

Medicaid992605365AGA

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sid's Place Incorporated's NPI number?

The NPI number for Sid's Place Incorporated is 1174823595. It was assigned to this organization in the NPPES registry on November 1, 2010.

Where is Sid's Place Incorporated located?

Sid's Place Incorporated is located at 2742 Luke Dr, Ellenwood, GA 30294. The listed phone number is (678) 557-8969.

What is Sid's Place Incorporated's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

When was this NPI record last updated?

The NPPES record for Sid's Place Incorporated was last updated on November 1, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.