MEDICARE: PERSONALIZED ADULT DAY SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	311ZA0620X	Adult Care Home Facility
3	372600000X	Adult Companion
4	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1184127177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONALIZED ADULT DAY SERVICES LLC

Provider Business Mailing Address
First Line	:	4714 AUGUSTA RD
Second Line	:
City	:	GARDEN CITY
State	:	GA
Zip	:	31408-1727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4714 AUGUSTA RD
Second Line	:
City	:	GARDEN CITY
State	:	GA
Zip	:	31408-1727
Country	:	US
Telephone Number	:	912-777-5679
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. ANTHONY WEST II
Credential	:
Telephone Number	:	912-507-7511

Provider Enumeration Date	:	03/15/2018
Last Update Date	:	01/22/2020

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