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General NPI Number Information
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NPI Number | 1861988420
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Entity Type | Organization
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Legal Business Name | SUNVERA HOME CARE LLC
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Dates
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Enumeration Date | 07/07/2018
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 240 YOUNGS CIR
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-2765
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Country | US
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Telephone | 770-462-0450
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Fax | 888-965-9774
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Provider Business Mailing Address
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Address Line | 240 YOUNGS CIR
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-2765
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Country | US
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Telephone | 678-576-2660
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Fax | 888-965-9774
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Authorized Official
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Title or Position | OWNER / ADMINISTRATOR
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Name | EDGARDO RIVERA
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Credential |
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Telephone | 678-576-2660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 056-R-1964
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License Number State | GA
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