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General NPI Number Information
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NPI Number | 1376905778
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Entity Type | Organization
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Legal Business Name | SKYLARK HOME CARE, LLC
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Dates
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Enumeration Date | 03/24/2016
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Last Update Date | 03/24/2016
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Provider Practice Location Address
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Address Line | 4265 JOHNS CREEK PKWY STE B
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City | SUWANEE
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State | GA
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Zip | 30024-6038
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Country | US
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Telephone | 678-646-0600
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Fax | 678-646-0602
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Provider Business Mailing Address
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Address Line | 4265 JOHNS CREEK PKWY STE B
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City | SUWANEE
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State | GA
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Zip | 30024-6038
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Country | US
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Telephone | 678-646-0600
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Fax | 678-646-0602
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Authorized Official
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Title or Position | CEO
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Name | MR. EDWIN HOWARD MORGENS
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Credential |
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Telephone | 404-550-7087
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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 | 058-R-0659
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License Number State | GA
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