Healthcare Provider Details

I. General information

NPI: 1861937443
Provider Name (Legal Business Name): DAILY GRACE ADULT DAY HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

868 HIGHWAY 49
MACON GA
31211
US

IV. Provider business mailing address

868 GA-49
MACON GA
31211
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-4700
  • Fax:
Mailing address:
  • Phone: 478-745-4700
  • Fax: 478-745-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADC000150
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberADC000150
License Number StateGA

VIII. Authorized Official

Name: MS. EULANDA LARA WALLER
Title or Position: ADMINISTRATOR
Credential: OTR/L
Phone: 478-318-2313