Provider Demographics
NPI:1265639512
Name:RACHEL HOUSE,INC
Entity Type:Organization
Organization Name:RACHEL HOUSE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORETHA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DORMINEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:229-549-6100
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:GA
Mailing Address - Zip Code:31647-0117
Mailing Address - Country:US
Mailing Address - Phone:229-549-6100
Mailing Address - Fax:229-549-6100
Practice Address - Street 1:204 W COLQUITT ST
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:GA
Practice Address - Zip Code:31647
Practice Address - Country:US
Practice Address - Phone:229-549-6100
Practice Address - Fax:229-549-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037-02-004-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000893241AMedicaid