# FUNDAMENTAL HEALTH GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BrightStar of NW Atlanta
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588098529
- **Authorized official:** MR. ADAM JACOB FRASER CSA (PRESIDENT)
- **Authorized official phone:** (404) 856-7610

## Contact information

- **Practice address:** 550 PEACHTREE ST NE, SUITE 1210, ATLANTA, GA 30308-2237
- **Practice address phone:** (404) 856-7610
- **Practice address fax:** (866) 266-5030
- **Mailing address:** 550 PEACHTREE ST NE, SUITE 1210, ATLANTA, GA 30308-2237
- **Mailing address phone:** (404) 856-7610
- **Mailing address fax:** (866) 266-5030

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251J00000X | Nursing Care Agency | — | — | — |
| 251S00000X | Community/Behavioral Health Agency | — | — | — |
| 253Z00000X | In Home Supportive Care Agency | — | — | Yes |

## Other

- **Enumeration date:** 08/27/2013
- **Last updated:** 05/28/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 060-R-1213 | HOME CARE PROVIDER LICENSE - SKILLED NURSING, PERSONAL CARE, & COMPANION/SITTER | GA |
| 01 | — | 563170 | JOINT COMMISSION ACCRED | GA |
| 01 | — | SCSA095804 | CERTIFIED SENIOR ADVISOR | GA |