Healthcare Provider Details

I. General information

NPI: 1659874493
Provider Name (Legal Business Name): GIFT TRANSITIONAL HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 03/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MARTIN LUTHER KING JR DR SW STE 420
ATLANTA GA
30310-5806
US

IV. Provider business mailing address

2001 MARTIN LUTHER KING JR DR SW STE 420
ATLANTA GA
30310-5806
US

V. Phone/Fax

Practice location:
  • Phone: 404-564-6486
  • Fax: 404-564-6487
Mailing address:
  • Phone: 404-564-6486
  • Fax: 404-564-6487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: GIFT NWANKWO
Title or Position: SECRETARY
Credential:
Phone: 404-564-6486