Healthcare Provider Details

I. General information

NPI: 1902197650
Provider Name (Legal Business Name): PROACTIVE HOME CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 IRWINTON RD
MILLEDGEVILLE GA
31061-9762
US

IV. Provider business mailing address

2624 IRWINTON RD
MILLEDGEVILLE GA
31061-9762
US

V. Phone/Fax

Practice location:
  • Phone: 478-452-2293
  • Fax: 478-452-2293
Mailing address:
  • Phone: 478-452-2293
  • Fax: 478-452-2293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number005-R-0386
License Number StateGA

VIII. Authorized Official

Name: MR. GEORGE NMN BARLOW
Title or Position: ADMINISTRATOR
Credential:
Phone: 478-452-2293