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General NPI Number Information
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NPI Number | 1003229667
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Entity Type | Organization
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Legal Business Name | ETI HEALTHCARE LLC
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 06/11/2014
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Provider Practice Location Address
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Address Line | 2170 BANKSTON CIR
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City | SNELLVILLE
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State | GA
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Zip | 30078-5718
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Country | US
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Telephone | 678-790-9333
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Fax |
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Provider Business Mailing Address
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Address Line | 2170 BANKSTON CIR
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City | SNELLVILLE
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State | GA
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Zip | 30078-5718
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Country | US
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Telephone | 678-790-9333
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. QUEENY ETIM
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Credential |
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Telephone | 678-790-9333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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