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General NPI Number Information
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NPI Number | 1043681521
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Entity Type | Organization
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Legal Business Name | SCENIC ROUTE ENTERPRISES INC
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 10/09/2015
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Provider Practice Location Address
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Address Line | 2371 HENRY CLOWER BLVD STE C
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City | SNELLVILLE
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State | GA
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Zip | 30078-7423
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Country | US
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Telephone | 770-982-6628
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Fax | 770-736-1065
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Provider Business Mailing Address
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Address Line | 2371 HENRY CLOWER BLVD STE C
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City | SNELLVILLE
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State | GA
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Zip | 30078-7423
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Country | US
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Telephone | 770-982-6628
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Fax | 770-736-1065
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DAVID STEWART
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Credential |
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Telephone | 770-982-6628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 067-R-0375
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License Number State | GA
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