Healthcare Provider Details

I. General information

NPI: 1861890022
Provider Name (Legal Business Name): CENTRAL GEORGIA ADULT DAY HEALTH & REHAB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2014
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 BACONSFIELD DR
MACON GA
31211-1400
US

IV. Provider business mailing address

770 BACONSFIELD DR
MACON GA
31211-1400
US

V. Phone/Fax

Practice location:
  • Phone: 487-714-3285
  • Fax:
Mailing address:
  • Phone: 487-714-3285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State

VIII. Authorized Official

Name: KALPESH G SHAH
Title or Position: PRESIDENT
Credential:
Phone: 487-714-3285