Provider Demographics
NPI:1558305813
Name:PLAZA HOME CARE INC
Entity Type:Organization
Organization Name:PLAZA HOME CARE INC
Other - Org Name:PLAZA HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-459-2999
Mailing Address - Street 1:220 W. WILSON ST.
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-1807
Mailing Address - Country:US
Mailing Address - Phone:770-459-2999
Mailing Address - Fax:770-459-2288
Practice Address - Street 1:220 W. WILSON ST.
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1807
Practice Address - Country:US
Practice Address - Phone:770-459-2999
Practice Address - Fax:770-459-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE005636332B00000X, 3336C0003X
332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00212066AMedicaid
1125841OtherNCPDP PIN
GA00212066BMedicaid
1125841OtherNCPDP PROVIDER IDENTIFICATION NUMBER
GA1125841OtherNCPDP PIN
GA000212066BMedicaid
GA0540740001Medicare NSC
GA1125841OtherNCPDP PIN