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General NPI Number Information
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NPI Number | 1205195476
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Entity Type | Organization
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Legal Business Name | AACADEMY ADULT DAY &SENIORLIIVING FACILITYLLC
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 05/09/2012
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Provider Practice Location Address
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Address Line | 168 DAVEDEHARAHARA DR
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City | SYLVANIA
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State | GA
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Zip | 30467
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Country | US
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Telephone | 912-564-2851
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Fax |
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Provider Business Mailing Address
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Address Line | 168 DAVEDEHARA DRIVE
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City | SYLVANIA
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State | GA
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Zip | 30467
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Country | US
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Telephone | 912-564-2851
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY S DAUGHTRY
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Credential |
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Telephone | 912-564-2851
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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 |
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License Number State |
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