Healthcare Provider Details

I. General information

NPI: 1710748066
Provider Name (Legal Business Name): URBANE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 BURGUNDY DR
GRIFFIN GA
30223-1196
US

IV. Provider business mailing address

1115 BURGUNDY DR
GRIFFIN GA
30223-1196
US

V. Phone/Fax

Practice location:
  • Phone: 954-955-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DOMINIQUE REBECCA STEWART
Title or Position: CEO
Credential:
Phone: 954-955-5500