Organization
OLIVE GARDEN HEALTHCARE SERV. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DORCAS BOLAJI (ADMINISTRATOR)
(678) 907-2089
Entity
Organization
Contact information
Practice address
90 COMMERCE DR STE A, FAYETTEVILLE, GA 30214-7519
(800) 256-5005
(404) 889-8661
Mailing address
1231 SWEETGUM TRL, CONYERS, GA 30012-3593
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
O56-R-0865
GA
Other
Enumeration date
08/02/2011
Last updated
08/02/2011
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