Provider Demographics
NPI:1720648132
Name:ULTICARE HEALTH AND HOME CARE AGENCY
Entity Type:Organization
Organization Name:ULTICARE HEALTH AND HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSELINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BALFOUR
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CCTN, CPN
Authorized Official - Phone:404-422-4149
Mailing Address - Street 1:4459 BELLEMEADE DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-4926
Mailing Address - Country:US
Mailing Address - Phone:404-422-4149
Mailing Address - Fax:770-637-2484
Practice Address - Street 1:4459 BELLEMEADE DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-4926
Practice Address - Country:US
Practice Address - Phone:404-422-4149
Practice Address - Fax:770-637-2484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health