Provider Demographics
NPI: | 1922367267 |
---|---|
Name: | RN4KIDZ, LLC |
Entity Type: | Organization |
Organization Name: | RN4KIDZ, LLC |
Other - Org Name: | RN4KIDZ |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | KYMBYATTA |
Authorized Official - Middle Name: | GASTON |
Authorized Official - Last Name: | EVANS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RN, BSN |
Authorized Official - Phone: | 678-310-5439 |
Mailing Address - Street 1: | 6496 BELLEVUE DR SW |
Mailing Address - Street 2: | |
Mailing Address - City: | CONYERS |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30094-4779 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 678-310-5439 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6496 BELLEVUE DR SW |
Practice Address - Street 2: | |
Practice Address - City: | CONYERS |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30094-4779 |
Practice Address - Country: | US |
Practice Address - Phone: | 678-310-5439 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-05-07 |
Last Update Date: | 2012-05-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | RN140835 | 251J00000X, 253Z00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251J00000X | Agencies | Nursing Care | |
No | 253Z00000X | Agencies | In Home Supportive Care |