MEDICARE: ONYXA CARE COLLECTIVE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	174200000X	Meals Provider
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	253Z00000X	In Home Supportive Care Agency
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
5	261QM0850X	Adult Mental Health Clinic/Center
6	261QM0855X	Adolescent and Children Mental Health Clinic/Center
7	3104A0625X	Assisted Living Facility (Mental Illness)
8	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1710865134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONYXA CARE COLLECTIVE LLC

Provider Business Mailing Address
First Line	:	8103 S PINE CONE DR
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-7662
Country	:	US
Telephone Number	:	470-855-5187
Fax Number	:

Provider Business Practice Location Address
First Line	:	8103 S PINE CONE DR
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-7662
Country	:	US
Telephone Number	:	470-855-5187
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER & EXECUTIVE DIRECTOR
Name	:	DANELLE RYDER
Credential	:
Telephone Number	:	470-855-5187

Provider Enumeration Date	:	08/25/2025
Last Update Date	:	08/25/2025

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Directions to “ONYXA CARE COLLECTIVE LLC ” Practice Location

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