Provider Demographics
NPI:1376893404
Name:PLATINUM ADULT DAYCARE
Entity Type:Organization
Organization Name:PLATINUM ADULT DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:4046685-476-3836
Mailing Address - Street 1:1658 SILVERGRASS LANE
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017
Mailing Address - Country:US
Mailing Address - Phone:404-668-5476
Mailing Address - Fax:
Practice Address - Street 1:1658 SILVERGRASS LN
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-1671
Practice Address - Country:US
Practice Address - Phone:404-668-5476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028905283314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility