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General NPI Number Information
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NPI Number | 1780943910
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Entity Type | Organization
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Legal Business Name | FIRST TRINITY HOMECARESERVICES INC.
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Dates
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Enumeration Date | 05/08/2012
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Last Update Date | 05/08/2012
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Provider Practice Location Address
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Address Line | 3965 BRADFORD WALK TRL
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City | BUFORD
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State | GA
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Zip | 30519-7840
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Country | US
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Telephone | 770-831-0013
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Fax | 770-831-0122
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Provider Business Mailing Address
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Address Line | 3965 BRADFORD WALK TRL
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City | BUFORD
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State | GA
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Zip | 30519-7840
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Country | US
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Telephone | 770-831-0013
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Fax | 770-831-0122
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | EMEKA JUSTIN OTIWU
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Credential | BBA
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Telephone | 770-355-4114
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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 | 067R0704
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 067R0704
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License Number State | GA
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