Provider Demographics
NPI:1902197650
Name:PROACTIVE HOME CARE SERVICES, INC.
Entity Type:Organization
Organization Name:PROACTIVE HOME CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:NMN
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-452-2293
Mailing Address - Street 1:2624 IRWINTON RD
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-9762
Mailing Address - Country:US
Mailing Address - Phone:478-452-2293
Mailing Address - Fax:478-452-2293
Practice Address - Street 1:2624 IRWINTON RD
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-9762
Practice Address - Country:US
Practice Address - Phone:478-452-2293
Practice Address - Fax:478-452-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005-R-0386311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility