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General NPI Number Information
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NPI Number | 1295643344
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Entity Type | Organization
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Legal Business Name | ETHEREAL GARDENS LLC
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Dates
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Enumeration Date | 08/31/2026
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Last Update Date | 08/31/2026
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Provider Practice Location Address
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Address Line | 3507 EMERY DR
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City | CARTERSVILLE
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State | GA
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Zip | 30121-3106
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Country | US
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Telephone | 770-744-1547
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Fax |
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Provider Business Mailing Address
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Address Line | 3507 EMERY DR
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City | CARTERSVILLE
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State | GA
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Zip | 30121-3106
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Country | US
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Telephone | 770-744-1547
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | SHANTE DIGGS
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Credential |
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Telephone | 470-361-9387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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