Provider Demographics
NPI:1346545274
Name:MY IDEAL CARE, LLC
Entity Type:Organization
Organization Name:MY IDEAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-236-0197
Mailing Address - Street 1:218 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5491
Mailing Address - Country:US
Mailing Address - Phone:229-236-0197
Mailing Address - Fax:229-255-2930
Practice Address - Street 1:218 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5491
Practice Address - Country:US
Practice Address - Phone:229-236-0197
Practice Address - Fax:229-255-2930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1346545274OtherTRICARE SOUTH REGION
AL129741Medicaid
GA1346545274OtherTRICARE SOUTH REGION