Provider Demographics
NPI:1346591187
Name:ULTRA CARE OF ETOWAH COUNTY
Entity Type:Organization
Organization Name:ULTRA CARE OF ETOWAH COUNTY
Other - Org Name:ULTRA CARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:706-324-7763
Mailing Address - Street 1:5820 VETERANS PKWY STE 109
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3453
Mailing Address - Country:US
Mailing Address - Phone:706-324-7763
Mailing Address - Fax:706-324-7792
Practice Address - Street 1:100 MEDICAL CENTER DR., SUITE 306
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1134
Practice Address - Country:US
Practice Address - Phone:256-459-4971
Practice Address - Fax:256-952-2153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health