Provider Demographics
NPI:1568808053
Name:MANGA HEALTH CONSULTANTS, DBA / REGIONAL
Entity Type:Organization
Organization Name:MANGA HEALTH CONSULTANTS, DBA / REGIONAL
Other - Org Name:REGIONAL HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:BOH
Authorized Official - Last Name:MANGA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, MSN
Authorized Official - Phone:678-863-2342
Mailing Address - Street 1:699 PATHVIEW CT
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7849
Mailing Address - Country:US
Mailing Address - Phone:770-237-8835
Mailing Address - Fax:770-237-8833
Practice Address - Street 1:699 PATHVIEW CT
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7849
Practice Address - Country:US
Practice Address - Phone:770-237-8835
Practice Address - Fax:770-237-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-11
Last Update Date:2013-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-R-0854163W00000X
GA37374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003130519AMedicaid
GA003130522AMedicaid