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General NPI Number Information
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NPI Number | 1548701006
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Entity Type | Organization
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Legal Business Name | SKYLARK ADH-JOHNS CREEK, LLC
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Dates
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Enumeration Date | 03/16/2017
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Last Update Date | 03/16/2017
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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 | 770-476-8400
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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 | 770-476-8400
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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 | 770-476-8400
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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 | ADC000089
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License Number State | GA
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