Provider Demographics
NPI:1528436227
Name:COMFORTERS ADULT DAYCARE
Entity type:Organization
Organization Name:COMFORTERS ADULT DAYCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:SAUNDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-457-5386
Mailing Address - Street 1:2753 TRAIL CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-2733
Mailing Address - Country:US
Mailing Address - Phone:678-457-5386
Mailing Address - Fax:678-401-3660
Practice Address - Street 1:5939 STEWART PKWY
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2371
Practice Address - Country:US
Practice Address - Phone:678-401-8076
Practice Address - Fax:678-401-3660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAADC000035311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA985179631AMedicaid