Provider Demographics
NPI:1083796106
Name:CKCG HEALTHCARE SERVICES,INC
Entity Type:Organization
Organization Name:CKCG HEALTHCARE SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:OKWUDILI
Authorized Official - Last Name:OBUROTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-209-9998
Mailing Address - Street 1:5995 OAKBROOK PKWY
Mailing Address - Street 2:SUITE -B
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093
Mailing Address - Country:US
Mailing Address - Phone:770-209-9998
Mailing Address - Fax:770-729-9861
Practice Address - Street 1:5995 OAKBROOK PKWY
Practice Address - Street 2:SUITE -B
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093
Practice Address - Country:US
Practice Address - Phone:770-209-9998
Practice Address - Fax:770-729-9861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R-01113140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA485426892BMedicaid
GA485426892AMedicaid
GA485426892BMedicaid