Provider Demographics
NPI:1043972987
Name:YOUR BEAUTIFUL DAYS LLC
Entity Type:Organization
Organization Name:YOUR BEAUTIFUL DAYS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JELANI
Authorized Official - Middle Name:
Authorized Official - Last Name:NURSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-723-1832
Mailing Address - Street 1:1040 WILLOW CREST LNDG
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-5737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1040 WILLOW CREST LNDG
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-5737
Practice Address - Country:US
Practice Address - Phone:213-435-5630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2021-006696OtherPCH PERMIT NUMBER