1235260258 NPI number — CHARITY PERSONAL CARE HOME L.L.C.

Table of content: DR. KERRY VICTOR RAGAIN PHD (NPI 1174772578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235260258 NPI number — CHARITY PERSONAL CARE HOME L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARITY PERSONAL CARE HOME L.L.C.
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:
1235260258
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:
2995 GARNET WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLEGE PARK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30349-8440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-519-5248
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2995 GARNET WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLEGE PARK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30349-8440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-519-5248
Provider Business Practice Location Address Fax Number:
770-473-3546
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EKPERI
Authorized Official First Name:
CHARITY
Authorized Official Middle Name:
CHINASA
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
404-519-5248

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , 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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