Provider Demographics
NPI:1174899462
Name:CCENO HOME HEALTHCARE SVCS, INC
Entity type:Organization
Organization Name:CCENO HOME HEALTHCARE SVCS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NDUBUISI
Authorized Official - Middle Name:GODWIN
Authorized Official - Last Name:OCHUBA
Authorized Official - Suffix:
Authorized Official - Credentials:BSC; MBA
Authorized Official - Phone:770-693-9465
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-0054
Mailing Address - Country:US
Mailing Address - Phone:770-693-9465
Mailing Address - Fax:877-832-2127
Practice Address - Street 1:5745 WENDY BAGWELL PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2805
Practice Address - Country:US
Practice Address - Phone:770-693-9465
Practice Address - Fax:877-832-2127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA110R0673251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health