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Organization

MACKLANDER, LLC

Active
Parent organization
MACKLANDER, LLC
Other names
Macksimum Alliance
Organization subpart
Yes

Provider details

NPI number
Legal business name
MACKLANDER, LLC
Authorized official
MRS. SHELLEY DIANE MACK (ADMINISTRATOR)
(706) 854-0555
Entity
Organization

Contact information

Practice address
1514 BALDWIN LAKES DR, GROVETOWN, GA 30813-5887
(706) 854-0555
(706) 651-9677
Mailing address
1514 BALDWIN LAKES DR, GROVETOWN, GA 30813-5887
(706) 854-0555
(706) 651-9677

Taxonomy

Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
036-R-0525
GA
261QD1600X
Developmental Disabilities Clinic/Center
Primary
036-R-0525
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
366878280A
GA
05
366878280B
GA
Enumeration date
01/28/2013
Last updated
01/28/2013
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