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General NPI Number Information
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NPI Number | 1689958076
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Entity Type | Organization
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Legal Business Name | BENNETT PCH
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 1877 SINGER WAY
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City | LITHONIA
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State | GA
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Zip | 30058
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Country | US
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Telephone | 678-791-5165
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Fax | 678-395-3902
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Provider Business Mailing Address
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Address Line | 1877 SINGER WAY
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City | LITHONIA
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State | GA
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Zip | 30058
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Country | US
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Telephone | 678-791-5165
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MICHELLE A BENNETT
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Credential | ETC
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Telephone | 678-791-5165
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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 | 000778
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License Number State | GA
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