Organization
PETLIN DIVERSIFIED SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA ANGELA MBAH NP (CEO)
(770) 595-8934
Entity
Organization
Contact information
Practice address
2817 LOST LAKES WAY, POWDER SPRINGS, GA 30127-6018
(770) 595-8934
Mailing address
2817 LOST LAKES WAY, POWDER SPRINGS, GA 30127-6018
(770) 595-8934
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
RN155427NP
GA
Other
Enumeration date
06/13/2008
Last updated
06/13/2008
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