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General NPI Number Information
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NPI Number | 1285224311
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Entity Type | Organization
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Legal Business Name | IDEAL HEALTHCARE PROVIDERS LLC
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Dates
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Enumeration Date | 01/22/2021
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 490 BRADLEY DR STE A
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-2019
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Country | US
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Telephone | 678-800-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 6595 ROSWELL RD STE G2375
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City | ATLANTA
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State | GA
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Zip | 30328-3152
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Country | US
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Telephone | 678-648-1891
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CHRISTEN JONES
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Credential |
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Telephone | 404-905-5089
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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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