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General NPI Number Information
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NPI Number | 1427304633
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Entity Type | Organization
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Legal Business Name | SUNSHINE DREAMASSISTED LIVING LLC
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 07/25/2012
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Provider Practice Location Address
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Address Line | 4841 LENORA CHURCH RD
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City | SNELLVILLE
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State | GA
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Zip | 30039-7707
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Country | US
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Telephone | 404-510-3888
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Fax | 678-344-4261
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Provider Business Mailing Address
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Address Line | 4841 LENORA CHURCH RD
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City | SNELLVILLE
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State | GA
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Zip | 30039-7707
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Country | US
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Telephone | 404-510-3888
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Fax | 678-344-4261
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Authorized Official
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Title or Position | CEO/DIRECTOR
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Name | MRS. BRENDA A SMITH
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Credential |
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Telephone | 404-510-3888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CLA000930
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License Number State | GA
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