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General NPI Number Information
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NPI Number | 1801230040
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Entity Type | Organization
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Legal Business Name | ANCHORTRUST HEALTH SYSTEMS INC.
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Dates
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Enumeration Date | 04/18/2013
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Last Update Date | 04/18/2013
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Provider Practice Location Address
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Address Line | 1989 HIGHWAY 138 SW
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City | RIVERDALE
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State | GA
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Zip | 30296-1880
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Country | US
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Telephone | 678-489-6673
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Fax | 678-489-6674
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Provider Business Mailing Address
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Address Line | PO BOX 490489
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City | ATLANTA
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State | GA
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Zip | 30349-0030
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. UGO UKUKU KALU
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Credential |
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Telephone | 404-663-9759
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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 | 033-R-1161
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License Number State | GA
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