Provider Demographics
NPI:1417155128
Name:ULTRA CARE LLC
Entity Type:Organization
Organization Name:ULTRA CARE LLC
Other - Org Name:RIGHT AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-640-1410
Mailing Address - Street 1:802 E MARTINTOWN RD
Mailing Address - Street 2:SUITE 157
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-5308
Mailing Address - Country:US
Mailing Address - Phone:803-278-0250
Mailing Address - Fax:
Practice Address - Street 1:114 PLEASANT HOME RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-3518
Practice Address - Country:US
Practice Address - Phone:706-855-5564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036-R-0010251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA036-R-0010OtherDEPT OF HR, ORS, HCP