1710288428 NPI number — CARECONNECT HEALTH, INC.

Table of content: (NPI 1710288428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710288428 NPI number — CARECONNECT HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARECONNECT HEALTH, 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:
1710288428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 5610
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORDELE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31010-1514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-273-8881
Provider Business Mailing Address Fax Number:
229-273-8985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 MAYO STREET
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
AMERICUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31709-3696
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-924-4647
Provider Business Practice Location Address Fax Number:
229-924-4597
Provider Enumeration Date:
11/11/2010

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
229-273-8881

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003106464A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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