Provider Demographics
NPI:1407295843
Name:CREUT HEALTH CARE, INC.
Entity Type:Organization
Organization Name:CREUT HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:CHINENYE
Authorized Official - Last Name:OKIYIE
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:678-591-4901
Mailing Address - Street 1:6982 MISTTOP LOOP
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-3060
Mailing Address - Country:US
Mailing Address - Phone:678-591-4901
Mailing Address - Fax:
Practice Address - Street 1:6982 MISTTOP LOOP
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-3060
Practice Address - Country:US
Practice Address - Phone:678-591-4901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREUT HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R-1067251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health