Provider Demographics
NPI:1831866771
Name:SOLACE GARDENS, LLC
Entity type:Organization
Organization Name:SOLACE GARDENS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YOULANDA
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:OUTIN
Authorized Official - Suffix:
Authorized Official - Credentials:BSB/MKT
Authorized Official - Phone:404-625-5478
Mailing Address - Street 1:4946 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-3680
Mailing Address - Country:US
Mailing Address - Phone:404-625-5478
Mailing Address - Fax:
Practice Address - Street 1:286 HIGHWAY 138 SW STE C
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4005
Practice Address - Country:US
Practice Address - Phone:404-625-5478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-27
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care