Provider Demographics
NPI:1700183365
Name:COMFORT COMMUNITY CENTER, LLC
Entity Type:Organization
Organization Name:COMFORT COMMUNITY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOHIREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-581-1831
Mailing Address - Street 1:700 SANDY PLAINS RD STE B14
Mailing Address - Street 2:SANDY PLAINS CONN
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6311
Mailing Address - Country:US
Mailing Address - Phone:678-581-1831
Mailing Address - Fax:678-581-1836
Practice Address - Street 1:700 SANDY PLAINS RD STE B14
Practice Address - Street 2:STE B14
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-6311
Practice Address - Country:US
Practice Address - Phone:678-581-1831
Practice Address - Fax:678-581-1836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00061603261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA702748549BMedicaid
GA702748549AMedicaid