Healthcare Provider Details

I. General information

NPI: 1164142022
Provider Name (Legal Business Name): SEVA ADULT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5675 JIMMY CARTER BLVD STE 665A
NORCROSS GA
30071-2955
US

IV. Provider business mailing address

510 BUTLER NATIONAL DR
JOHNS CREEK GA
30097-5944
US

V. Phone/Fax

Practice location:
  • Phone: 770-317-4533
  • 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: CHIRAG DATTA
Title or Position: VICE PRESIDENT
Credential:
Phone: 404-556-2754