Provider Demographics
NPI:1689923534
Name:EKD FAMILY SERVICES
Entity Type:Organization
Organization Name:EKD FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EULA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERASSA
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:404-933-7223
Mailing Address - Street 1:1581 SUMMIT POND RD
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-5473
Mailing Address - Country:US
Mailing Address - Phone:678-344-6602
Mailing Address - Fax:
Practice Address - Street 1:1581 SUMMIT POND RD
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-5473
Practice Address - Country:US
Practice Address - Phone:678-344-6602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EKD COMMUNITY OPPORTUNITY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization