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General NPI Number Information
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NPI Number | 1164829453
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Entity Type | Organization
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Legal Business Name | OZRIM, LLC
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Dates
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Enumeration Date | 12/02/2014
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 3512 WINDRIDGE DR
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City | MARIETTA
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State | GA
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Zip | 30066-2657
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Country | US
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Telephone | 770-551-9533
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Fax | 770-551-0302
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Provider Business Mailing Address
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Address Line | 1725 MOUNT VERNON RD SUITE 4
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City | DUNWOODY
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State | GA
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Zip | 30338-4240
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Country | US
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Telephone | 770-551-9533
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Fax | 770-551-0302
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LISA MARLEEN REISMAN
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Credential | NURSE PRACTITIONER
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Telephone | 770-551-9533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | CLA002159
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License Number State | GA
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