SOUTHERN CRESCENT PERSONAL CARE HOME
NPI 1639235047
Assisted Living Facility in Griffin, GA
- Organization
- Assisted Living Facility
- CLIA Number: 11D0257984
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 02-16-2028
About SOUTHERN CRESCENT PERSONAL CARE HOME
This page provides the complete NPI Profile along with additional information for Southern Crescent Personal Care Home, a provider established in Griffin, Georgia operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1639235047 assigned on December 2006. The practitioner's primary taxonomy code is 310400000X with license number 031030131 (GA). The provider is registered as an organization and their NPI record was last updated 18 years ago. The authorized official of this NPI record is Stephanie Odom (Ceo)
- NPI
- 1639235047 Verify this NPI
- Provider Name
- SOUTHERN CRESCENT PERSONAL CARE HOME
- Entity Type
- Organization
- Location Address
- 630 MERIWETHER ST GRIFFIN, GA 30224
- Location Phone
- (770) 233-8116
- Location Fax
- (770) 233-8482
- Mailing Address
- 125 HIGHWAY 138 SW RIVERDALE, GA 30274
- Mailing Phone
- (678) 610-4429
- Mailing Fax
- (678) 610-4478
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 12-29-2006
- Last Update Date
- 07-22-2008
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Assisted Living Facility
- Taxonomy Code
- 310400000X
- Type
- Nursing & Custodial Care Facilities
- License No.
- 031030131
- License State
- GA
- Taxonomy Description
- 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.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 040319876A | MEDICAID (05) | GA |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 11D0257984
- Facility Type
- Physician Office
- Certificate Effective Date
- February 17, 2026
- Certificate Expiration Date
- February 16, 2028
- Laboratory Director
- UMA M. KUMAR
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Southern Crescent Personal Care Home in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
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Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
GRIFFIN, GA 30224
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1639235047, enumerated as an "organization" on December 29, 2006.
The provider is located at 630 MERIWETHER ST GRIFFIN, GA 30224 and the phone number is (770) 233-8116.
Assisted Living Facility with taxonomy code 310400000X.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
