MEDICARE: A PEACE OF MIND ADULT DAY HEALTH CARE CENTER, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1386915452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A PEACE OF MIND ADULT DAY HEALTH CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	3565 AUSTELL RD SW
Second Line	:	SUITE 1063
City	:	MARIETTA
State	:	GA
Zip	:	30008-5769
Country	:	US
Telephone Number	:	770-438-0999
Fax Number	:

Provider Business Practice Location Address
First Line	:	3565 AUSTELL RD SW
Second Line	:	SUITE 1063
City	:	MARIETTA
State	:	GA
Zip	:	30008-5769
Country	:	US
Telephone Number	:	770-438-0999
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. KATIE MAE HENDERSON-WILLIAMS
Credential	:	R.N., B.S.N.
Telephone Number	:	678-945-9290

Provider Enumeration Date	:	01/22/2012
Last Update Date	:	01/22/2012

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