1124458427 NPI number — FIRST CORINTHIAN HOMECARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124458427 NPI number — FIRST CORINTHIAN HOMECARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST CORINTHIAN HOMECARE, INC.
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:
Provider Other Organization Name Type Code:
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:
1124458427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 S DOOLY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEZUMA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31063-1603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-472-0150
Provider Business Mailing Address Fax Number:
478-472-0157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 S DOOLY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEZUMA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31063-1603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-472-0150
Provider Business Practice Location Address Fax Number:
478-472-0157
Provider Enumeration Date:
11/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
IBEGBULAM
Authorized Official First Name:
TED
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
478-472-0161

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  046-R-1142 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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