MEDICARE: ADULT DAY CARE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1740669316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADULT DAY CARE

Provider Business Mailing Address
First Line	:	879 CARRIAGE RUN CT
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-2414
Country	:	US
Telephone Number	:	404-917-4346
Fax Number	:	866-493-9554

Provider Business Practice Location Address
First Line	:	7040 LAKELAND AVE N STE 207B
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55428-5622
Country	:	US
Telephone Number	:	404-917-4346
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LEJA FAITH LO
Credential	:
Telephone Number	:	404-917-4346

Provider Enumeration Date	:	05/28/2015
Last Update Date	:	04/17/2019

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Directions to “ADULT DAY CARE ” Practice Location

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