Provider Demographics
NPI:1558637637
Name:SPECIALIZED ADULT CARE INC,
Entity Type:Organization
Organization Name:SPECIALIZED ADULT CARE INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGEMENT
Authorized Official - Phone:678-641-1828
Mailing Address - Street 1:2370 BATTLE FOREST DR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2628
Mailing Address - Country:US
Mailing Address - Phone:678-641-1828
Mailing Address - Fax:770-627-3360
Practice Address - Street 1:2370 BATTLE FOREST DR SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-2628
Practice Address - Country:US
Practice Address - Phone:678-641-1828
Practice Address - Fax:770-627-3360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003-R-0407305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA033-R-0407OtherPRIVATE HOME CARE PROVIDER