Provider Demographics
NPI:1932327657
Name:MM ADULT CARE, INC.
Entity type:Organization
Organization Name:MM ADULT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:MADISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-467-9362
Mailing Address - Street 1:23 HIDDEN LAKES RD
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31001-2837
Mailing Address - Country:US
Mailing Address - Phone:229-467-9362
Mailing Address - Fax:229-467-2185
Practice Address - Street 1:23 HIDDEN LAKES RD
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31001-2837
Practice Address - Country:US
Practice Address - Phone:229-467-9362
Practice Address - Fax:229-467-2185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA156-R-0001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA635993234AMedicaid
GA635993234CMedicaid
GA635993234BMedicaid