Provider Demographics
NPI:1457869141
Name:PRIDE HEALTHCARE STAFFING LLC
Entity Type:Organization
Organization Name:PRIDE HEALTHCARE STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDIBAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-333-5281
Mailing Address - Street 1:3449 ALLIE DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-7105
Mailing Address - Country:US
Mailing Address - Phone:404-484-8048
Mailing Address - Fax:770-686-3109
Practice Address - Street 1:3449 ALLIE DR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-7105
Practice Address - Country:US
Practice Address - Phone:404-484-8048
Practice Address - Fax:770-686-3109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-R-1905251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health