Provider Demographics
NPI:1013643741
Name:JANIC HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:JANIC HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-964-6494
Mailing Address - Street 1:778 RAYS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3107
Mailing Address - Country:US
Mailing Address - Phone:678-626-6696
Mailing Address - Fax:404-478-8409
Practice Address - Street 1:778 RAYS RD STE 103
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3107
Practice Address - Country:US
Practice Address - Phone:678-626-6696
Practice Address - Fax:404-478-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHCP011489OtherGEORGIA DEPARTMENT OF COMMUNITY HEALTH - DCH