Healthcare Provider Details

I. General information

NPI: 1801104468
Provider Name (Legal Business Name): SENIOR WAY HOUSING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

674 MOUNT ZION RD SUITE B
JONESBORO GA
30236-1561
US

IV. Provider business mailing address

674 MOUNT ZION RD SUITE B
JONESBORO GA
30236-1561
US

V. Phone/Fax

Practice location:
  • Phone: 678-422-1841
  • Fax:
Mailing address:
  • Phone:
  • 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: MYRLENE HOYTE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 678-422-1841