Healthcare Provider Details

I. General information

NPI: 1194106310
Provider Name (Legal Business Name): FIRST AID COMMUNITY HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3562 HABERSHAM AT NORTHLAKE
TUCKER GA
30084-4010
US

IV. Provider business mailing address

3562 HABERSHAM AT NORTHLAKE
TUCKER GA
30084-4010
US

V. Phone/Fax

Practice location:
  • Phone: 770-270-2231
  • Fax: 770-270-2234
Mailing address:
  • Phone: 770-270-2231
  • Fax: 770-270-2234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES ABEL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 770-270-2231