Healthcare Provider Details

I. General information

NPI: 1316285315
Provider Name (Legal Business Name): LIZZY'S ADULT COMMUNITY SERVICE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 BALDWIN LAKES DR
GROVETOWN GA
30813-5887
US

IV. Provider business mailing address

1514 BALDWIN LAKES DR
GROVETOWN GA
30813-5887
US

V. Phone/Fax

Practice location:
  • Phone: 706-533-0218
  • Fax: 706-869-2015
Mailing address:
  • Phone: 706-533-0218
  • Fax: 706-869-2015

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. MELVIN PARKER III
Title or Position: ADMINISTRATOR
Credential:
Phone: 706-533-0218