Provider Demographics
NPI:1427377704
Name:CROWN HEALTHCARE LLC
Entity Type:Organization
Organization Name:CROWN HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:BADE
Authorized Official - Last Name:ODERINDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-714-6901
Mailing Address - Street 1:155 WESTRIDGE PKWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3049
Mailing Address - Country:US
Mailing Address - Phone:404-289-2500
Mailing Address - Fax:404-748-4520
Practice Address - Street 1:155 WESTRIDGE PKWY
Practice Address - Street 2:SUITE 106
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3049
Practice Address - Country:US
Practice Address - Phone:404-289-2500
Practice Address - Fax:404-748-4520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036658332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1356437040OtherNPI
GA08BDMHWMedicare UPIN