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General NPI Number Information
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NPI Number | 1376893404
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Entity Type | Organization
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Legal Business Name | PLATINUM ADULT DAYCARE
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 1658 SILVERGRASS LN
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City | GRAYSON
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State | GA
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Zip | 30017-1671
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Country | US
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Telephone | 404-668-5476
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Fax |
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Provider Business Mailing Address
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Address Line | 1658 SILVERGRASS LANE
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City | GRAYSON
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State | GA
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Zip | 30017
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Country | US
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Telephone | 404-668-5476
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | GLENDA MORGAN HALL
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Credential |
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Telephone | 40466854763836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | CN0028905283
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License Number State | GA
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