Provider Demographics
NPI:1760615280
Name:ABSOLUTE FAMILY PCH
Entity Type:Organization
Organization Name:ABSOLUTE FAMILY PCH
Other - Org Name:1ST CHOICE TRANSITIONAL LIVING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHILANDIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WIMBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-394-8093
Mailing Address - Street 1:2516 COLEMAN AVE.
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906
Mailing Address - Country:US
Mailing Address - Phone:706-364-7588
Mailing Address - Fax:706-364-7588
Practice Address - Street 1:2035 OLD SAVANNAH RD.
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901
Practice Address - Country:US
Practice Address - Phone:706-394-8093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121013181305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service