1205803525 NPI number — CRISP HOME CARE

Table of content: MEGAN LIN HULL MSCP (NPI 1891529723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205803525 NPI number — CRISP HOME CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRISP HOME CARE
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:
1205803525
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 N 5TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORDELE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31015-3254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-271-9686
Provider Business Mailing Address Fax Number:
229-271-9689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 N 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORDELE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31015-3254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-271-9686
Provider Business Practice Location Address Fax Number:
229-271-9689
Provider Enumeration Date:
03/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SARATSIOTIS
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
BRIDGES
Authorized Official Title or Position:
PATIENT ACCOUNTING DIRECTOR
Authorized Official Telephone Number:
229-271-9686

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  040R0003 , 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)