Provider Demographics
NPI:1194092742
Name:RATLIFF PRIVATE HOME CARE
Entity type:Organization
Organization Name:RATLIFF PRIVATE HOME CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRAWICK
Authorized Official - Suffix:
Authorized Official - Credentials:RNNURSE PRACTITIONAL
Authorized Official - Phone:478-295-2626
Mailing Address - Street 1:187 ROBERSON MILL RD NE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-4960
Mailing Address - Country:US
Mailing Address - Phone:478-295-2626
Mailing Address - Fax:478-295-2630
Practice Address - Street 1:187 ROBERSON MILL RD NE
Practice Address - Street 2:SUITE 110
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-4960
Practice Address - Country:US
Practice Address - Phone:478-295-2626
Practice Address - Fax:478-295-2630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005-R-0273253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1255633368Medicare PIN