Healthcare Provider Details

I. General information

NPI: 1457555138
Provider Name (Legal Business Name): RETIRE CARE INVESTMENT COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 PATTERSON ST
BYROMVILLE GA
31007
US

IV. Provider business mailing address

712 PATTERSON ST
BYROMVILLE GA
31007
US

V. Phone/Fax

Practice location:
  • Phone: 229-268-7510
  • Fax: 229-268-4716
Mailing address:
  • Phone: 229-268-7510
  • Fax: 229-268-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number3688
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number3688
License Number StateGA

VIII. Authorized Official

Name: RICK FALLAW
Title or Position: OWNER
Credential:
Phone: 229-268-7510