Sid's Place Incorporated
NPI 1174823595ActiveOrganization· Assisted Living Facility· Ellenwood, GA
Assisted Living Facility in Ellenwood, Georgia, registered in NPPES in November 2010. The authorized official on file is Zannie Darrell Black, Owner.
Overview
| NPI | 1174823595 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Nov 1, 2010 |
| Last updated in NPPES | Nov 1, 2010 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Assisted Living Facility Primary | 310400000X | 031012928 | GA |
| Community Based Residential Treatment Facility, Mental Illness | 320800000X | 031012928 | GA |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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