Healthcare Provider Details

I. General information

NPI: 1376297473
Provider Name (Legal Business Name): CREATING MAGICAL MEMORIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 PERIMETER CTR E STE 150
ATLANTA GA
30346-2210
US

IV. Provider business mailing address

3106 KINGS BAY DR
DECATUR GA
30034-7118
US

V. Phone/Fax

Practice location:
  • Phone: 800-871-5339
  • Fax:
Mailing address:
  • Phone: 800-871-5339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHANTALIA COOPER
Title or Position: OWNER
Credential:
Phone: 404-246-8276