Provider Demographics
NPI:1841619269
Name:COTTAGE ADULT DAY SERVICE INC
Entity Type:Organization
Organization Name:COTTAGE ADULT DAY SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAC KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-978-9696
Mailing Address - Street 1:1142 ATHENS HWY
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1709
Mailing Address - Country:US
Mailing Address - Phone:770-978-9696
Mailing Address - Fax:
Practice Address - Street 1:1142 ATHENS HWY
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-1709
Practice Address - Country:US
Practice Address - Phone:770-978-9696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
GA14000773305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No305R00000XManaged Care OrganizationsPreferred Provider Organization