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General NPI Number Information
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NPI Number | 1194453274
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Entity Type | Organization
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Legal Business Name | EN VIDA ADULT DAY CARE CENTER LLC
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 150 MEDICAL WAY STE E
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City | RIVERDALE
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State | GA
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Zip | 30274-2533
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Country | US
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Telephone | 404-956-9698
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Fax |
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Provider Business Mailing Address
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Address Line | 949 CHURCH ST
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City | DECATUR
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State | GA
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Zip | 30030-1872
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Country | US
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Telephone | 404-956-9698
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KATARRA ASHLEY
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Credential |
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Telephone | 404-956-9698
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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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