Provider Demographics
NPI:1306036900
Name:MIKE ROGERS ENTERPRISES
Entity Type:Organization
Organization Name:MIKE ROGERS ENTERPRISES
Other - Org Name:HOME HELPERS AND DIRECT LINK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-983-1855
Mailing Address - Street 1:1490 HEATHERGLADE LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-9776
Mailing Address - Country:US
Mailing Address - Phone:678-983-1855
Mailing Address - Fax:770-736-4807
Practice Address - Street 1:1490 HEATHERGLADE LN
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-9776
Practice Address - Country:US
Practice Address - Phone:678-983-1855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067R0349251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health