1013925932 NPI number — MEMORIAL CAREONE HOME HEALTH SERVICES INC

Table of content: REBECCA L COTE MSPT (NPI 1215089909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013925932 NPI number — MEMORIAL CAREONE HOME HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL CAREONE HOME HEALTH SERVICES 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:
6
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:
1013925932
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 931861
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:
31198-1861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-350-6405
Provider Business Mailing Address Fax Number:
912-350-6413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 ALBANY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYCROSS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31501-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-285-2222
Provider Business Practice Location Address Fax Number:
912-285-5441
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILDES
Authorized Official First Name:
DEANNA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
912-350-6559

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  148110 , 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)

  • Identifier: 00336861A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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