1033428289 NPI number — HOMEFIRST HEALTHCARE SERVICES, LLC

Table of content: (NPI 1033428289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033428289 NPI number — HOMEFIRST HEALTHCARE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMEFIRST HEALTHCARE SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AVEANNA HEATLHCARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033428289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 INTERSTATE NORTH PKWY SE STE 1600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30339-5047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-248-8740
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 W. 25TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-962-5345
Provider Business Practice Location Address Fax Number:
844-414-3194
Provider Enumeration Date:
10/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WHITESIDE
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR REGULATORY SERVICES
Authorized Official Telephone Number:
770-248-8740

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X , with the licence number:  HC0092 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X , with the licence number: HC0092 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253Z00000X , with the licence number: HC0092 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6602189 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100661 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3418977 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com