Healthcare Provider Details

I. General information

NPI: 1871931279
Provider Name (Legal Business Name): ADULT HOMES SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 FRONTAGE RD E
SYLVANIA GA
30467-4800
US

IV. Provider business mailing address

803 BEST BRIDGE RD
SYLVANIA GA
30467-8216
US

V. Phone/Fax

Practice location:
  • Phone: 912-564-1148
  • Fax: 912-564-0015
Mailing address:
  • Phone: 912-564-1148
  • Fax: 912-564-0015

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: MR. RICHARD EVANS
Title or Position: PRESIDENT
Credential:
Phone: 912-536-5546