Provider Demographics
NPI:1508265059
Name:CHYCHYS HEALTH CARE AND MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:CHYCHYS HEALTH CARE AND MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHYCHY
Authorized Official - Middle Name:
Authorized Official - Last Name:OKOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-216-8202
Mailing Address - Street 1:3875 POWDER SPRINGS RD
Mailing Address - Street 2:SUITE C-3
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-2759
Mailing Address - Country:US
Mailing Address - Phone:678-855-6522
Mailing Address - Fax:
Practice Address - Street 1:3875 POWDER SPRINGS RD
Practice Address - Street 2:SUITE C-3
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-2759
Practice Address - Country:US
Practice Address - Phone:678-855-6522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033-R-1115251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003141540AMedicaid