Healthcare Provider Details

I. General information

NPI: 1548731680
Provider Name (Legal Business Name): RED ROSE ADULT DAY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2148 BANKHEAD HWY STE B&C
CARROLLTON GA
30116-7989
US

IV. Provider business mailing address

3621 MORINDA DR
DOUGLASVILLE GA
30135-7275
US

V. Phone/Fax

Practice location:
  • Phone: 770-834-0078
  • Fax:
Mailing address:
  • Phone: 404-396-8140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. TERRY JOEL LAMOTHE
Title or Position: OWNER
Credential:
Phone: 404-396-8140