1source Fitness & Sports Neuro Rehab
Home Health in Snellville, GA. Organization (NPI-2).
NPI number1184174161
StatusActive
Last updated in NPPESOct 13, 2016
Details
- NPI
- 1184174161
- Entity type
- Organization (NPI-2)
- Legal business name
- 1source Fitness & Sports Neuro Rehab
- Organization subpart
- Yes
- Enumeration date
- Oct 13, 2016
- Last updated
- Oct 13, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251E00000X | Home Health | 12002969 | GA | Yes |
Other names
- 1source Health Services (Other Name)
Practice location
4728 Joseph Eli DrSnellville, GA 30039-7138
Phone 678-257-4037 · Fax 678-257-4037
Mailing address
4728 Joseph Eli DrSnellville, GA 30039-7138
Phone 678-257-4037 · Fax 678-257-4037
Authorized official
Collin Adu
Clinical Director
6782504035
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