Provider Demographics
NPI:1972588002
Name:M.G.R. HOMECARE, INC
Entity Type:Organization
Organization Name:M.G.R. HOMECARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:770-228-6371
Mailing Address - Street 1:1012 MEMORIAL DR
Mailing Address - Street 2:STE. 4
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-4411
Mailing Address - Country:US
Mailing Address - Phone:770-228-6371
Mailing Address - Fax:770-229-5443
Practice Address - Street 1:1012 MEMORIAL DR
Practice Address - Street 2:STE. 4
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-4411
Practice Address - Country:US
Practice Address - Phone:770-228-6371
Practice Address - Fax:770-229-5443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000187778AMedicaid
GA000187778AMedicaid