Provider Demographics
NPI:1962249706
Name:PROACTIVE DEVELOPMENT CARE
Entity type:Organization
Organization Name:PROACTIVE DEVELOPMENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHLYTHIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLECKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-691-9269
Mailing Address - Street 1:5195 COTTER COURT
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291
Mailing Address - Country:US
Mailing Address - Phone:470-691-9269
Mailing Address - Fax:
Practice Address - Street 1:5195 COTTER COURT
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291
Practice Address - Country:US
Practice Address - Phone:470-691-9269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care