Provider Demographics
NPI:1700434081
Name:DULUTH HEALTHCARE SYSTEMS LLC
Entity Type:Organization
Organization Name:DULUTH HEALTHCARE SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:UGBAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-334-3116
Mailing Address - Street 1:1254 BEAVER RUIN RD STE 302
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3224
Mailing Address - Country:US
Mailing Address - Phone:866-235-2448
Mailing Address - Fax:770-305-6281
Practice Address - Street 1:1254 BEAVER RUIN RD STE 302
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3224
Practice Address - Country:US
Practice Address - Phone:866-235-2448
Practice Address - Fax:770-305-6281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health