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General NPI Number Information
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NPI Number | 1639342496
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Entity Type | Organization
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Legal Business Name | RG&G INC
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Dates
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Enumeration Date | 04/11/2008
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 4750 E MOODY BLVD SUITE 206
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City | BUNNELL
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State | FL
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Zip | 32110-7709
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Country | US
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Telephone | 386-447-5272
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Fax | 386-447-5223
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Provider Business Mailing Address
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Address Line | 4750 E MOODY BLVD SUITE 206
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City | BUNNELL
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State | FL
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Zip | 32110-7709
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Country | US
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Telephone | 386-447-5272
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Fax | 386-447-5223
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TIMOTHY JOHN O'DONNELL
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Credential |
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Telephone | 385-447-5272
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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 | 233615
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License Number State | FL
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