| NPI | 1710306402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | USHA AGARWAL Provider 678-578-0914 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 281P00000X Chronic Disease Hospital (Licence: FL 207RI0200X) |
| Additional Taxonomies | 282E00000X (Licence: FL 207RI0200X) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2019-07-12 |