Healthcare Provider Details

I. General information

NPI: 1114468543
Provider Name (Legal Business Name): USA ADULT DAYCARE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2017
Last Update Date: 03/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6088 BUFORD HWY NE
DORAVILLE GA
30340-1334
US

IV. Provider business mailing address

6185 BUFORD HWY BUILDING C1
PEACHTREE CORNERS GA
30071-2350
US

V. Phone/Fax

Practice location:
  • Phone: 678-469-1638
  • Fax:
Mailing address:
  • Phone: 678-469-1638
  • 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: DANIEL NGUYEN
Title or Position: OWNER
Credential:
Phone: 678-469-1638