Healthcare Provider Details

I. General information

NPI: 1225806920
Provider Name (Legal Business Name): PRUDENT SENIOR SERVICES OF AMERICA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 HOLCOMB BRIDGE RD STE 350
PEACHTREE CORNERS GA
30092-5292
US

IV. Provider business mailing address

3850 HOLCOMB BRIDGE RD STE 350
PEACHTREE CORNERS GA
30092-5292
US

V. Phone/Fax

Practice location:
  • Phone: 770-870-0500
  • Fax:
Mailing address:
  • Phone: 770-870-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: SAMEER SHAH
Title or Position: CEO
Credential:
Phone: 313-215-5158