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General NPI Number Information
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NPI Number | 1306036900
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Entity Type | Organization
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Legal Business Name | MIKE ROGERS ENTERPRISES
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 1490 HEATHERGLADE LN
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-9776
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Country | US
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Telephone | 678-983-1855
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Fax |
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Provider Business Mailing Address
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Address Line | 1490 HEATHERGLADE LN
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-9776
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Country | US
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Telephone | 678-983-1855
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Fax | 770-736-4807
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Authorized Official
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Title or Position | OWNER
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Name | MS. ANGELA D ACK
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Credential |
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Telephone | 678-983-1855
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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 | 067R0349
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License Number State | GA
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