Provider Demographics
NPI:1265219091
Name:DENHAVENS PCH, INC.
Entity type:Organization
Organization Name:DENHAVENS PCH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MODICUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-441-1000
Mailing Address - Street 1:3675 CRESTWOOD PKWY NW STE 400
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5054
Mailing Address - Country:US
Mailing Address - Phone:404-441-1000
Mailing Address - Fax:
Practice Address - Street 1:3675 CRESTWOOD PKWY NW STE 400
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5054
Practice Address - Country:US
Practice Address - Phone:404-441-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health