Provider Demographics
NPI:1487126066
Name:SKYLARK ADH-ATLANTA LLC
Entity type:Organization
Organization Name:SKYLARK ADH-ATLANTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:MORGENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-410-1510
Mailing Address - Street 1:4265 JOHNS CREEK PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6038
Mailing Address - Country:US
Mailing Address - Phone:404-410-1510
Mailing Address - Fax:678-646-0602
Practice Address - Street 1:1705 COMMERCE DR NW STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-3107
Practice Address - Country:US
Practice Address - Phone:404-410-1510
Practice Address - Fax:678-646-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care