Provider Demographics
NPI:1912605379
Name:INTABWE COMMUNITY,INC
Entity Type:Organization
Organization Name:INTABWE COMMUNITY,INC
Other - Org Name:INTABWE COMMUNITY,INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:NDIKUMUKIZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-964-2147
Mailing Address - Street 1:605 ASHLEY PL
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3395
Mailing Address - Country:US
Mailing Address - Phone:404-964-2147
Mailing Address - Fax:
Practice Address - Street 1:3938 E PONCE DE LEON AVE STE D
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-8104
Practice Address - Country:US
Practice Address - Phone:404-964-2147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Multi-Specialty