Provider Demographics
NPI:1568903805
Name:SKYLARK ADH-POWERS FERRY, LLC
Entity Type:Organization
Organization Name:SKYLARK ADH-POWERS FERRY, LLC
Other - Org Name:SKYLARK ADULT DAY CENTER OF COBB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:MORGENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-476-8400
Mailing Address - Street 1:120 INTERSTATE NORTH PARKWAY EAST, SE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2164
Mailing Address - Country:US
Mailing Address - Phone:678-741-3900
Mailing Address - Fax:678-741-3901
Practice Address - Street 1:120 INTERSTATE NORTH PKWY EAST, SE
Practice Address - Street 2:SUITE 420
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2164
Practice Address - Country:US
Practice Address - Phone:678-741-3900
Practice Address - Fax:678-741-3901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKYLARK SENIOR CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAADC000088261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA383600128CMedicaid
GA383600128DMedicaid
GA949972040AMedicaid