Healthcare Provider Details

I. General information

NPI: 1053895003
Provider Name (Legal Business Name): CIRCLE OF LOVE ADULT DAY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7116 PEACHTREE INDUSTRIAL BLVD BLDG 4
PEACHTREE CORNERS GA
30071
US

IV. Provider business mailing address

7116 PEACHTREE INDUSTRIAL BLVD BLDG 4
PEACHTREE CORNERS GA
30071
US

V. Phone/Fax

Practice location:
  • Phone: 470-289-2222
  • 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: ALFRED SOMBOUN YIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 404-454-7979