Provider Demographics
NPI:1528340965
Name:MONTE HOME CARE
Entity type:Organization
Organization Name:MONTE HOME CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:G
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-742-2544
Mailing Address - Street 1:PO BOX 5559
Mailing Address - Street 2:780 BACONFIELD OFFICE PARK BLDG#3 224
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-5559
Mailing Address - Country:US
Mailing Address - Phone:478-742-2544
Mailing Address - Fax:
Practice Address - Street 1:214 BRADSTONE CIR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-4566
Practice Address - Country:US
Practice Address - Phone:478-742-2544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011-R-0039251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health