Provider Demographics
NPI: | 1184334567 |
---|---|
Name: | ATLANTA HEALTHCARE, LLC |
Entity type: | Organization |
Organization Name: | ATLANTA HEALTHCARE, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MONIQUE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | COLLINS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MBA |
Authorized Official - Phone: | 470-541-2101 |
Mailing Address - Street 1: | 600 HOUZE WAY STE D5 |
Mailing Address - Street 2: | |
Mailing Address - City: | ROSWELL |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30076-1433 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 470-541-2101 |
Mailing Address - Fax: | 404-907-1277 |
Practice Address - Street 1: | 600 HOUZE WAY STE D5 |
Practice Address - Street 2: | |
Practice Address - City: | ROSWELL |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30076-1433 |
Practice Address - Country: | US |
Practice Address - Phone: | 470-541-2101 |
Practice Address - Fax: | 404-907-1277 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-11-28 |
Last Update Date: | 2022-11-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 163WH0200X | Nursing Service Providers | Registered Nurse | Home Health | Group - Multi-Specialty |
No | 163WP0000X | Nursing Service Providers | Registered Nurse | Pain Management | Group - Multi-Specialty |
No | 163WW0000X | Nursing Service Providers | Registered Nurse | Wound Care | Group - Multi-Specialty |
No | 164W00000X | Nursing Service Providers | Licensed Practical Nurse | Group - Multi-Specialty | |
No | 164X00000X | Nursing Service Providers | Licensed Vocational Nurse | Group - Multi-Specialty | |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
No | 207QG0300X | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | Group - Single Specialty |
No | 282NC0060X | Hospitals | General Acute Care Hospital | Critical Access | Group - Single Specialty |
No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | ||
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 372600000X | Nursing Service Related Providers | Adult Companion | Group - Multi-Specialty | |
No | 3747P1801X | Nursing Service Related Providers | Technician | Personal Care Attendant | Group - Multi-Specialty |
No | 374U00000X | Nursing Service Related Providers | Home Health Aide | Group - Multi-Specialty | |
No | 376K00000X | Nursing Service Related Providers | Nurse's Aide | Group - Multi-Specialty |