Provider Demographics
NPI:1699199554
Name:CARE CHOICE ADULT DEVELOPMENT PROGRAM INC
Entity Type:Organization
Organization Name:CARE CHOICE ADULT DEVELOPMENT PROGRAM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAMITKO
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-864-8290
Mailing Address - Street 1:1075 PEACHTREE ST NE STE 3650
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3934
Mailing Address - Country:US
Mailing Address - Phone:404-965-3899
Mailing Address - Fax:
Practice Address - Street 1:1075 PEACHTREE ST NE STE 3650
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3934
Practice Address - Country:US
Practice Address - Phone:404-965-3899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization