Organization
GRACE OASIS PERSONAL CARE HOME LLC
Active
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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