Provider Demographics
NPI:1710192927
Name:ARICARE HEALTHCARE SERVICES &MED SUPPLY
Entity Type:Organization
Organization Name:ARICARE HEALTHCARE SERVICES &MED SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:NKWOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-447-8170
Mailing Address - Street 1:7001 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 400 H
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-3673
Mailing Address - Country:US
Mailing Address - Phone:700-447-8170
Mailing Address - Fax:770-409-8926
Practice Address - Street 1:7001 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 400 H
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-3673
Practice Address - Country:US
Practice Address - Phone:700-447-8170
Practice Address - Fax:770-409-8926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-R-0056251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health