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General NPI Number Information
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NPI Number | 1679087274
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Entity Type | Organization
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Legal Business Name | MISTY SUE'S ADULT DAY HEALTH CENTER LLC
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 11/20/2017
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Provider Practice Location Address
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Address Line | 517 HILL ST
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City | MONROE
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State | GA
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Zip | 30656-1507
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Country | US
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Telephone | 770-267-7995
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Fax |
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Provider Business Mailing Address
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Address Line | 517 HILL ST
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City | MONROE
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State | GA
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Zip | 30656-1507
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Country | US
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Telephone | 770-267-7995
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | NATASHA SHORT
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Credential |
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Telephone | 678-986-4042
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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 | ADC00203
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License Number State | GA
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