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General NPI Number Information
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NPI Number | 1033654322
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Entity Type | Organization
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Legal Business Name | LIVING SPRING ADULT DAY CARE & SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 12/22/2016
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 1044 FIELD VIEW DR
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City | MCDONOUGH
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State | GA
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Zip | 30253-9021
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Country | US
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Telephone | 862-224-0967
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Fax |
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Provider Business Mailing Address
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Address Line | 1044 FIELD VIEW DR
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City | MCDONOUGH
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State | GA
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Zip | 30253-9021
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Country | US
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Telephone | 862-224-0967
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Fax |
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Authorized Official
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Title or Position | MGR.
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Name | JAMES BRIGNOLLE
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Credential |
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Telephone | 862-224-0967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 16112118
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License Number State | GA
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