Healthcare Provider Details

I. General information

NPI: 1922367267
Provider Name (Legal Business Name): RN4KIDZ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 05/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6496 BELLEVUE DR SW
CONYERS GA
30094-4779
US

IV. Provider business mailing address

6496 BELLEVUE DR SW
CONYERS GA
30094-4779
US

V. Phone/Fax

Practice location:
  • Phone: 678-310-5439
  • Fax:
Mailing address:
  • Phone: 678-310-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberRN140835
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberRN140835
License Number StateGA

VIII. Authorized Official

Name: MRS. KYMBYATTA GASTON EVANS
Title or Position: DIRECTOR
Credential: RN, BSN
Phone: 678-310-5439