Healthcare Provider Details

I. General information

NPI: 1548701006
Provider Name (Legal Business Name): SKYLARK ADH-JOHNS CREEK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4265 JOHNS CREEK PKWY STE B
SUWANEE GA
30024-6038
US

IV. Provider business mailing address

4265 JOHNS CREEK PKWY STE B
SUWANEE GA
30024-6038
US

V. Phone/Fax

Practice location:
  • Phone: 770-476-8400
  • Fax: 678-646-0602
Mailing address:
  • Phone: 770-476-8400
  • Fax: 678-646-0602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADC000089
License Number StateGA

VIII. Authorized Official

Name: MR. EDWIN HOWARD MORGENS
Title or Position: CEO
Credential:
Phone: 770-476-8400