Provider Demographics
NPI:1417008566
Name:PRN POOL INC
Entity Type:Organization
Organization Name:PRN POOL INC
Other - Org Name:CAREMASTER MEDICAL SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:GROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-227-1264
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-0007
Mailing Address - Country:US
Mailing Address - Phone:770-227-1264
Mailing Address - Fax:770-228-9986
Practice Address - Street 1:240 ODELL RD
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4787
Practice Address - Country:US
Practice Address - Phone:770-227-1264
Practice Address - Fax:770-228-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADHR126R0002251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000536962HMedicaid