Provider Demographics
NPI:1023339918
Name:MONIX CARE
Entity type:Organization
Organization Name:MONIX CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-771-1559
Mailing Address - Street 1:1901 BOULDER GATE DR
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-1680
Mailing Address - Country:US
Mailing Address - Phone:770-771-1559
Mailing Address - Fax:
Practice Address - Street 1:1901 BOULDER GATE DR
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-1680
Practice Address - Country:US
Practice Address - Phone:770-771-1559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044017532320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA931572633AMedicaid