License Type Code = General
License Number = 1000641
Licensee Name = CENTRAL GA ADULT DAY HEALTH
Business Name = CENTRAL GA ADULT HEALTH
Business Address Line1 = 770 BACONSFIELD DRIVE
Business Address Line2 =
Business Address Line3 =
Business City = MACON
Business State = GA
Business Zip = 31211
Primary Phone = (478) 714-3285
Contact Name = KALPESHCHANDRA G SHAH (MIKE)
License Status = Active
Start Of Business Date = 2015-04-17
Out Of Business Date =
Contractor = No
Application Date = 2015-04-17
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