1821090135 NPI number — MRS HOMECARE, INC.

Table of content: (NPI 1821090135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821090135 NPI number — MRS HOMECARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MRS 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:
MRS OF FITZGERALD
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:
1821090135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 568
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31702-0568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-439-2403
Provider Business Mailing Address Fax Number:
229-883-8426

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 NORMAN DORMINY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FITZGERALD
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31750-8858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-423-4545
Provider Business Practice Location Address Fax Number:
229-423-8610
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RIDDLE
Authorized Official First Name:
E
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
229-439-2403

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000238697H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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