Provider Demographics
NPI:1063263929
Name:PLATINUM HEALTHCARE SERVICES
Entity type:Organization
Organization Name:PLATINUM HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:OBICHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-822-4505
Mailing Address - Street 1:935 LANIER AVE W STE 1008
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7434
Mailing Address - Country:US
Mailing Address - Phone:404-902-5811
Mailing Address - Fax:678-311-5519
Practice Address - Street 1:935 LANIER AVE W STE 1008
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7434
Practice Address - Country:US
Practice Address - Phone:404-902-5811
Practice Address - Fax:678-311-5519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility