Provider Demographics
NPI:1366198582
Name:EMPIRE INTERNATIONAL CARE CENTER
Entity type:Organization
Organization Name:EMPIRE INTERNATIONAL CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:470-489-7917
Mailing Address - Street 1:PO BOX 491232
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30049-0021
Mailing Address - Country:US
Mailing Address - Phone:470-881-2206
Mailing Address - Fax:470-945-4151
Practice Address - Street 1:3505 SKYLAND DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-8962
Practice Address - Country:US
Practice Address - Phone:470-222-5694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No174200000XOther Service ProvidersMeals
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4840464OtherHOME HEALTH
GA632146OtherHOME HEALTH