Provider Demographics
NPI:1477922748
Name:PURE CARE CENTER
Entity type:Organization
Organization Name:PURE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-212-9297
Mailing Address - Street 1:3675 CRESTWOOD PKWY NW
Mailing Address - Street 2:SUITE290
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1805
Mailing Address - Country:US
Mailing Address - Phone:770-212-9297
Mailing Address - Fax:
Practice Address - Street 1:3675 CRESTWOOD PKWY NW
Practice Address - Street 2:SUITE 290
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1805
Practice Address - Country:US
Practice Address - Phone:770-212-9297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty