=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801244611
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SR SEABREEZE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2016
-----------------------------------------------------
Last Update Date | 06/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4625 ALEXANDER DR STE 210
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30022-3719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-343-6235
-----------------------------------------------------
Fax | 678-735-7554
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4625 ALEXANDER DR STE 210
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30022-3719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-343-6235
-----------------------------------------------------
Fax | 678-735-7554
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROB BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-343-6235
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 060-R-0715
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------