Provider Demographics
NPI:1699058883
Name:FIRST CORINTHIAN HOMECARE, INC.
Entity type:Organization
Organization Name:FIRST CORINTHIAN HOMECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:IBEGBULAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-627-5029
Mailing Address - Street 1:2759 DELK RD SE
Mailing Address - Street 2:SUITE 2550
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8847
Mailing Address - Country:US
Mailing Address - Phone:770-627-5029
Mailing Address - Fax:770-485-5361
Practice Address - Street 1:2759 DELK RD SE
Practice Address - Street 2:SUITE 2550
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8847
Practice Address - Country:US
Practice Address - Phone:770-627-5029
Practice Address - Fax:770-485-5361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033-R-0815251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003123352AMedicaid