Provider Demographics
NPI:1043213358
Name:MRS HOMECARE, INC.
Entity Type:Organization
Organization Name:MRS HOMECARE, INC.
Other - Org Name:MRS OF MOULTRIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:E.
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:RIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-439-2403
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31702-0568
Mailing Address - Country:US
Mailing Address - Phone:229-439-2403
Mailing Address - Fax:229-883-8426
Practice Address - Street 1:2467A S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6531
Practice Address - Country:US
Practice Address - Phone:229-890-6949
Practice Address - Fax:229-890-7386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000238697KMedicaid
GA000238697KMedicaid