=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437776408
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGO HEALTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2020
-----------------------------------------------------
Last Update Date | 06/25/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2140 MCGEE RD STE C550C
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-7006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-573-3577
-----------------------------------------------------
Fax | 770-234-5115
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2140 MCGEE RD STE C550C
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-7006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-573-3577
-----------------------------------------------------
Fax | 770-234-5115
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | UGOCHUKWU DESMOND ANIGBOGU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-573-3577
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------