Provider Demographics
NPI:1659600716
Name:MEDCIPHERS LLC
Entity Type:Organization
Organization Name:MEDCIPHERS LLC
Other - Org Name:MDC HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-973-2700
Mailing Address - Street 1:5950 LIVE OAK PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1743
Mailing Address - Country:US
Mailing Address - Phone:404-973-2700
Mailing Address - Fax:
Practice Address - Street 1:5950 LIVE OAK PKWY STE 220
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1743
Practice Address - Country:US
Practice Address - Phone:404-973-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA122-R-0582251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health