Provider Demographics
NPI:1801244611
Name:SR SEABREEZE, INC.
Entity type:Organization
Organization Name:SR SEABREEZE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-343-6235
Mailing Address - Street 1:4625 ALEXANDER DR
Mailing Address - Street 2:STE 210
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-3719
Mailing Address - Country:US
Mailing Address - Phone:770-343-6235
Mailing Address - Fax:678-735-7554
Practice Address - Street 1:4625 ALEXANDER DR
Practice Address - Street 2:STE 210
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-3719
Practice Address - Country:US
Practice Address - Phone:770-343-6235
Practice Address - Fax:678-735-7554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R-0715253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003151809AMedicaid