Provider Demographics
NPI:1285974741
Name:PRESIDENTIAL CARE INC.
Entity type:Organization
Organization Name:PRESIDENTIAL CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MBA
Authorized Official - Middle Name:UKOHA
Authorized Official - Last Name:KALU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:404-625-3566
Mailing Address - Street 1:6322 WINDY RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-6630
Mailing Address - Country:US
Mailing Address - Phone:404-625-3566
Mailing Address - Fax:
Practice Address - Street 1:6322 WINDY RIDGE WAY
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-6630
Practice Address - Country:US
Practice Address - Phone:404-625-3566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health