Healthcare Provider Details

I. General information

NPI: 1235907932
Provider Name (Legal Business Name): PRUDENT SENIOR SERVICES OF AMERICA
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: 770-454-7979
  • Fax:
Mailing address:
  • Phone: 770-454-7979
  • 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: WOOIYI TAN YIN
Title or Position: COO
Credential:
Phone: 770-612-1388