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General NPI Number Information
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NPI Number | 1225806920
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Entity Type | Organization
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Legal Business Name | PRUDENT SENIOR SERVICES OF AMERICA, INC.
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Dates
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Enumeration Date | 12/13/2023
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 3850 HOLCOMB BRIDGE RD STE 350
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City | PEACHTREE CORNERS
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State | GA
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Zip | 30092-5292
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Country | US
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Telephone | 770-870-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 3850 HOLCOMB BRIDGE RD STE 350
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City | PEACHTREE CORNERS
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State | GA
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Zip | 30092-5292
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Country | US
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Telephone | 770-870-0500
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SAMEER SHAH
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Credential |
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Telephone | 313-215-5158
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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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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