Provider Demographics
NPI:1881824928
Name:TEDLA-KEBEDE CORP
Entity Type:Organization
Organization Name:TEDLA-KEBEDE CORP
Other - Org Name:NIRVANA HOME HEALTH CARE SVCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WOUBSHET
Authorized Official - Middle Name:
Authorized Official - Last Name:TEDLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-861-1411
Mailing Address - Street 1:3424 OLD SUTTONS WAY
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4187
Mailing Address - Country:US
Mailing Address - Phone:404-861-1411
Mailing Address - Fax:
Practice Address - Street 1:3424 OLD SUTTONS WAY
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4187
Practice Address - Country:US
Practice Address - Phone:404-861-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility