Provider Demographics
NPI:1891091625
Name:NEW JERUSALEM ADULT DAY CARE CENTER
Entity Type:Organization
Organization Name:NEW JERUSALEM ADULT DAY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:EDMONDSON
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:770-981-7408
Mailing Address - Street 1:5721 MILLER GROVE RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4823
Mailing Address - Country:US
Mailing Address - Phone:770-298-0640
Mailing Address - Fax:
Practice Address - Street 1:5721 MILLER GROVE RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4823
Practice Address - Country:US
Practice Address - Phone:770-981-7408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA727252881AMedicaid