Healthcare Provider Details

I. General information

NPI: 1982910261
Provider Name (Legal Business Name): MORE CARE II INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5038 STORY MILL RD
HEPHZIBAH GA
30815-4814
US

IV. Provider business mailing address

5038 STORY MILL RD
HEPHZIBAH GA
30815-4814
US

V. Phone/Fax

Practice location:
  • Phone: 706-360-1813
  • Fax: 706-790-9925
Mailing address:
  • Phone: 706-360-1813
  • Fax: 706-790-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number326100127D
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number326100127D
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number326100127C
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number326100127B
License Number StateGA

VIII. Authorized Official

Name: MS. CLARA A OWOLABI
Title or Position: DIRECTOR
Credential: MA,BS,LPN
Phone: 706-360-1813