Provider Demographics
NPI:1275085581
Name:JERICHO ADULT DAY CARE CENTER INC.
Entity Type:Organization
Organization Name:JERICHO ADULT DAY CARE CENTER INC.
Other - Org Name:JERICHO ADULT DAYCARE CENTER INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-477-5644
Mailing Address - Street 1:2100 KENNINGTON CT
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2620
Mailing Address - Country:US
Mailing Address - Phone:770-477-5644
Mailing Address - Fax:770-477-5647
Practice Address - Street 1:409 ARROWHEAD BLVD
Practice Address - Street 2:B-8
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1255
Practice Address - Country:US
Practice Address - Phone:770-477-5644
Practice Address - Fax:770-477-5647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000737283BMedicaid