Healthcare Provider Details

I. General information

NPI: 1255640983
Provider Name (Legal Business Name): OUR PARENTS PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7081 SOUTHLAKE PARKWAY
MORROW GA
30260
US

IV. Provider business mailing address

7081 SOUTHLAKE PARKWAY
MORROW GA
30260
US

V. Phone/Fax

Practice location:
  • Phone: 404-917-6643
  • Fax:
Mailing address:
  • Phone: 404-917-6643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number00000000011
License Number StateGA

VIII. Authorized Official

Name: MS. VIVIAN T BELOVED
Title or Position: CEO
Credential:
Phone: 404-917-6643