Provider Demographics
NPI:1114127883
Name:STAY WELL CARE SOLUTIONS, INC.
Entity type:Organization
Organization Name:STAY WELL CARE SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:YANINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUZNETSOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-889-4327
Mailing Address - Street 1:22 EXECUTIVE PARK DR NE
Mailing Address - Street 2:SUITE 2250
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 EXECUTIVE PARK DRIVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2206
Practice Address - Country:US
Practice Address - Phone:404-551-2363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care