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General NPI Number Information
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NPI Number | 1063386340
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Entity Type | Organization
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Legal Business Name | CAEDRACARE HEALTH LLC
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Dates
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Enumeration Date | 10/01/2025
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Last Update Date | 03/25/2026
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Provider Practice Location Address
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Address Line | 1274 ROCK CHAPEL RD
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City | LITHONIA
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State | GA
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Zip | 30058-5833
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Country | US
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Telephone | 706-459-1875
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Fax | 678-476-1699
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Provider Business Mailing Address
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Address Line | 1833 STEPHENSON RD
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City | LITHONIA
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State | GA
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Zip | 30058-5942
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Country | US
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Telephone | 470-886-8125
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Fax | 678-476-1699
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Authorized Official
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Title or Position | SENIOR MANAGEMENT
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Name | GODWIN MOYO
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Credential |
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Telephone | 470-886-8125
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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