1174899462 NPI number — CCENO HOME HEALTHCARE SVCS, INC

Table of content: MS. ELIANNY D GUTIERREZ SIRIT (NPI 1639901770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174899462 NPI number — CCENO HOME HEALTHCARE SVCS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CCENO HOME HEALTHCARE SVCS, 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:
1174899462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 54
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POWDER SPRINGS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30127-0054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-693-9465
Provider Business Mailing Address Fax Number:
877-832-2127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5745 WENDY BAGWELL PKWY
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
HIRAM
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30141-2805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-693-9465
Provider Business Practice Location Address Fax Number:
877-832-2127
Provider Enumeration Date:
03/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
OCHUBA
Authorized Official First Name:
NDUBUISI
Authorized Official Middle Name:
GODWIN
Authorized Official Title or Position:
PROGRAM ADMINISTRATOR
Authorized Official Telephone Number:
770-693-9465

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  110R0673 , 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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