Provider Demographics
NPI:1649545864
Name:MORNING STAR PERSONAL CARE INC.
Entity type:Organization
Organization Name:MORNING STAR PERSONAL CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HULEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-982-3585
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-0477
Mailing Address - Country:US
Mailing Address - Phone:678-982-3585
Mailing Address - Fax:
Practice Address - Street 1:2193 HUDSON DR SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-4722
Practice Address - Country:US
Practice Address - Phone:678-982-3585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA162202887BMedicaid
GA162202887CMedicaid