Provider Demographics
NPI:1548285422
Name:PROHEALTH RESOURCE GROUP, INC.
Entity type:Organization
Organization Name:PROHEALTH RESOURCE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:FALLAW
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:229-268-7510
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:1300 EAST UNION ST
Mailing Address - City:VIENNA
Mailing Address - State:GA
Mailing Address - Zip Code:31092-0549
Mailing Address - Country:US
Mailing Address - Phone:229-268-7510
Mailing Address - Fax:229-268-4716
Practice Address - Street 1:1300 E UNION ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:GA
Practice Address - Zip Code:31092-7541
Practice Address - Country:US
Practice Address - Phone:229-268-7510
Practice Address - Fax:229-268-4716
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAL HEALTH HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-13
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000718517AMedicaid
GA6116030001Medicare NSC