Provider Demographics
NPI:1568617546
Name:KING DAVID COMMUNITY CENTER OF ATLANTA, INC.
Entity Type:Organization
Organization Name:KING DAVID COMMUNITY CENTER OF ATLANTA, INC.
Other - Org Name:ADULT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KHANO
Authorized Official - Middle Name:
Authorized Official - Last Name:ARANBAYEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-931-8591
Mailing Address - Street 1:5054 SINGLETON RD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-2503
Mailing Address - Country:US
Mailing Address - Phone:770-931-8591
Mailing Address - Fax:770-931-8609
Practice Address - Street 1:5054 SINGLETON RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2503
Practice Address - Country:US
Practice Address - Phone:770-931-8591
Practice Address - Fax:770-931-8609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-R-0586253Z00000X
261QA0600X
GA332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No253Z00000XAgenciesIn Home Supportive Care
No332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA355137600BMedicaid
GA000811137IMedicaid
GA000811137PMedicaid
GA355137600CMedicaid
GA000811137CMedicaid
GA000811137OMedicaid
GA000811137FMedicaid
GA000811137DMedicaid
GA000811137JMedicaid
GA000811137KMedicaid