Provider Demographics
NPI:1659026565
Name:EMERGE HEALING CENTER LLC
Entity Type:Organization
Organization Name:EMERGE HEALING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DIFABIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-203-3998
Mailing Address - Street 1:411 JASMINE CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-7716
Mailing Address - Country:US
Mailing Address - Phone:770-203-3998
Mailing Address - Fax:
Practice Address - Street 1:6110 MCFARLAND STATION DR STE 1104
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6801
Practice Address - Country:US
Practice Address - Phone:770-203-3998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility