1760533541 NPI number — VEMANDAL NURSING SERVICES INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760533541 NPI number — VEMANDAL NURSING SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VEMANDAL NURSING 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:
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:
1760533541
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1563
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOUGLASVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30133-1563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-577-7327
Provider Business Mailing Address Fax Number:
770-577-6573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34OO CHAPEL HILL ROAD
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
DOUGLASVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-577-7327
Provider Business Practice Location Address Fax Number:
770-577-6573
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MAYO
Authorized Official First Name:
PATIENCE
Authorized Official Middle Name:
AYUK
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
770-577-7327

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X , with the licence number: 048-R-0024 , 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: 040968984B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040968984C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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