Organization
GRACE OASIS PERSONAL CARE HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SARAH PRESIDENT RN, DDP (ADMINISTRATOR/MANAGER)
(770) 616-7758
Entity
Organization
Contact information
Practice address
2629 HILDERBRAND DR, DOUGLASVILLE, GA 30135-5135
(770) 616-7758
Mailing address
2629 HILDERBRAND DR, DOUGLASVILLE, GA 30135-5135
(770) 616-7758
(770) 489-0822
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
CLA000784
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105768106A
PAYEE ID NUMBER
GA
01
—
512346476A
CRA NUMBER
GA
Enumeration date
07/10/2013
Last updated
07/10/2013
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