Provider Demographics
NPI:1780652164
Name:ROCKDALE MEDICAL CENTER HOME HEALTH
Entity Type:Organization
Organization Name:ROCKDALE MEDICAL CENTER HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-918-3958
Mailing Address - Street 1:1412 MILSTEAD AVE NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3877
Mailing Address - Country:US
Mailing Address - Phone:770-918-3958
Mailing Address - Fax:770-918-3967
Practice Address - Street 1:1412 MILSTEAD AVE NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3877
Practice Address - Country:US
Practice Address - Phone:770-918-3958
Practice Address - Fax:770-918-3967
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKDALE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-10
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA122195251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00752485AMedicaid
GA117111Medicare Oscar/Certification