Provider Demographics
NPI:1912200841
Name:ABC HEALTHCARE OF AMERICA, LLC.
Entity Type:Organization
Organization Name:ABC HEALTHCARE OF AMERICA, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PHILOMENA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-612-2395
Mailing Address - Street 1:5756 HARRIER LN
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-8868
Mailing Address - Country:US
Mailing Address - Phone:678-612-2395
Mailing Address - Fax:678-519-3043
Practice Address - Street 1:5756 HARRIER LN
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-8868
Practice Address - Country:US
Practice Address - Phone:678-612-2395
Practice Address - Fax:678-519-3043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA522154775AMedicaid