Healthcare Provider Details

I. General information

NPI: 1699199554
Provider Name (Legal Business Name): CARE CHOICE ADULT DEVELOPMENT PROGRAM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 PEACHTREE ST NE STE 3650
ATLANTA GA
30309-3934
US

IV. Provider business mailing address

1075 PEACHTREE ST NE STE 3650
ATLANTA GA
30309-3934
US

V. Phone/Fax

Practice location:
  • Phone: 404-965-3899
  • Fax:
Mailing address:
  • Phone: 404-965-3899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAMITKO L MOORE
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 248-864-8290