MEDICARE: ADONIS PERSONAL CARE HONE, INC

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	310400000X	Assisted Living Facility	PCH007114	GA

General Provider Information

NPI Number	:	1760742779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADONIS PERSONAL CARE HONE, INC

Provider Business Mailing Address
First Line	:	1409 GREENVIEW WAY
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-3039
Country	:	US
Telephone Number	:	770-717-2751
Fax Number	:

Provider Business Practice Location Address
First Line	:	1409 GREENVIEW WAY
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-3039
Country	:	US
Telephone Number	:	770-717-2751
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. HYE K HWANG
Credential	:
Telephone Number	:	770-717-2751

Provider Enumeration Date	:	05/23/2012
Last Update Date	:	05/23/2012

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