Provider Demographics
NPI:1336619220
Name:CONSECRATED CARE INC
Entity Type:Organization
Organization Name:CONSECRATED CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TASHAWNKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-862-2020
Mailing Address - Street 1:5930 GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-6055
Mailing Address - Country:US
Mailing Address - Phone:678-862-2020
Mailing Address - Fax:
Practice Address - Street 1:217 ARROWHEAD BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1169
Practice Address - Country:US
Practice Address - Phone:770-472-9110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder