Provider Demographics
NPI:1518907286
Name:ULTRA CARE OF GEORGIA, INC
Entity Type:Organization
Organization Name:ULTRA CARE OF GEORGIA, INC
Other - Org Name:ULTRA HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICKEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-324-7763
Mailing Address - Street 1:5820 VETERANS PKWY STE 109
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3453
Mailing Address - Country:US
Mailing Address - Phone:706-324-7763
Mailing Address - Fax:706-324-7792
Practice Address - Street 1:5820 VETERANS PKWY STE 109
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3453
Practice Address - Country:US
Practice Address - Phone:706-324-7763
Practice Address - Fax:706-324-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106-273-H251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA117140Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER