Healthcare Provider Details

I. General information

NPI: 1740479864
Provider Name (Legal Business Name): A CHANGE OF CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 TWIN TENDRILS SW
ATLANTA GA
30331-7271
US

IV. Provider business mailing address

360 TWIN TENDRILS SW
ATLANTA GA
30331-7271
US

V. Phone/Fax

Practice location:
  • Phone: 404-680-8851
  • Fax:
Mailing address:
  • Phone: 404-680-8851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberRN168077
License Number StateGA

VIII. Authorized Official

Name: RENAE LYNN HOLLIDAY
Title or Position: NURSING CONSULTANT/EXECUTIVE DIRECT
Credential: RN
Phone: 404-680-8851