Healthcare Provider Details

I. General information

NPI: 1376893404
Provider Name (Legal Business Name): PLATINUM ADULT DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1658 SILVERGRASS LN
GRAYSON GA
30017-1671
US

IV. Provider business mailing address

1658 SILVERGRASS LANE
GRAYSON GA
30017
US

V. Phone/Fax

Practice location:
  • Phone: 404-668-5476
  • Fax:
Mailing address:
  • Phone: 404-668-5476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberCN0028905283
License Number StateGA

VIII. Authorized Official

Name: GLENDA MORGAN HALL
Title or Position: DIRECTOR
Credential:
Phone: 40466854763836