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General NPI Number Information
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NPI Number | 1750712964
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Entity Type | Organization
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Legal Business Name | COMPANION CONNECTIONS
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Dates
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Enumeration Date | 12/13/2013
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Last Update Date | 12/13/2013
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Provider Practice Location Address
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Address Line | 4852 DAINTREE CT
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-6439
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Country | US
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Telephone | 678-933-1024
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Fax |
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Provider Business Mailing Address
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Address Line | 4852 DAINTREE CT
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-6439
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ANGELA J MOORE
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Credential |
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Telephone | 678-933-1024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | BUS-0030285-11
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License Number State | GA
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