Provider Demographics
NPI:1477877298
Name:ESSENT HEALTHCARE - GEORGETOWN LLC
Entity Type:Organization
Organization Name:ESSENT HEALTHCARE - GEORGETOWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:FICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-312-5108
Mailing Address - Street 1:474 HOME ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GEORGETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45121-1459
Mailing Address - Country:US
Mailing Address - Phone:937-378-7150
Mailing Address - Fax:937-378-7151
Practice Address - Street 1:474 HOME ST
Practice Address - Street 2:SUITE C
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121-1459
Practice Address - Country:US
Practice Address - Phone:937-378-7150
Practice Address - Fax:937-378-7151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSENT HEALTHCARE - GEORGETOWN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-23
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health