1710017702 NPI number — INTOUCH HOME CARE SERVICES

Table of content: CHRISTOPHER ROBERT BOOTH PSYD (NPI 1568893162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710017702 NPI number — INTOUCH HOME CARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTOUCH HOME CARE SERVICES
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:
1710017702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CHASE RIDGE LN
Provider Second Line Business Mailing Address:
1655
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-377-5515
Provider Business Mailing Address Fax Number:
770-236-3326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1655 CHASE RIDGE LN
Provider Second Line Business Practice Location Address:
1655
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30043-4369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-377-5515
Provider Business Practice Location Address Fax Number:
770-236-3326
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
IGBINOSUN
Authorized Official First Name:
KINGSLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
678-377-5515

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  067-R-0228 , 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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