Organization
SUNDANCE
Active
Parent organization
NO
Organization subpart
Yes
Provider details
NPI number
Legal business name
NO
Authorized official
MRS. SHEMILY MATHEW (PT)
(207) 992-6007
Entity
Organization
Contact information
Practice address
145 COX FARM RD NW, MARIETTA, GA 30064-5059
(207) 992-6007
Mailing address
145 COX FARM RD NW, MARIETTA, GA 30064-5059
(207) 992-6007
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
PT010530
GA
Other
Enumeration date
11/23/2012
Last updated
11/23/2012
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