Provider Demographics
NPI:1245453620
Name:PREVENTIVE CARE SERVICES, INC.
Entity type:Organization
Organization Name:PREVENTIVE CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:EAVES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:770-319-8201
Mailing Address - Street 1:3961 FLOYD RD # 300335
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8535
Mailing Address - Country:US
Mailing Address - Phone:770-319-8201
Mailing Address - Fax:770-234-3890
Practice Address - Street 1:3961 FLOYD RD # 300335
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8535
Practice Address - Country:US
Practice Address - Phone:770-319-8201
Practice Address - Fax:770-234-3890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00653573AMedicaid
TNH445131Medicaid