Healthcare Provider Details

I. General information

NPI: 1114127883
Provider Name (Legal Business Name): STAY WELL CARE SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 EXECUTIVE PARK DRIVE NE
ATLANTA GA
30329-2206
US

IV. Provider business mailing address

22 EXECUTIVE PARK DR NE SUITE 2250
ATLANTA GA
30329-2206
US

V. Phone/Fax

Practice location:
  • Phone: 404-551-2363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name: YANINA KUZNETSOV
Title or Position: TREASURER
Credential:
Phone: 201-889-4327