NPIMap

Organization Active NPI

Supplemental Health Care

  • Nursing Care Agency
  • Atlanta, GA
National Provider Identifier
1164574711
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Care AgencyTaxonomy code 251J00000X
License
56131 Issued in GA
Legal business name
SUPPLEMENTAL HEALTH CARE
Practice address
6849 Peachtree Dunwoody Rd NE
NE St. 102 BLDG B1
Atlanta, GA 30328-1610
Phone
(866) 587-9922
Fax
(678) 587-9993
NPI assigned
Jan 16, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mike Jacoutot
Title
Ceo
Phone
(800) 456-6677

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

National Provider Directory
Tax ID family
Supplemental42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

Organizations that report the same tax identification number in the National Provider Directory.

View all 41

Locations

6849 Peachtree Dunwoody Rd
Bldg B1
Sandy Springs, GA 30328
Phone (866) 587-9922

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Care Agency 251J00000X 56131 GA Primary

Addresses

NPPES NPI Registry

Primary practice location

6849 Peachtree Dunwoody Rd NE
NE St. 102 BLDG B1
Atlanta, GA 30328-1610

Mailing address

1640 West Redstone Center Drive
Suite 200
Park City, UT 84098
Phone (800) 456-6677

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164574711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 WEST REDSTONE CENTER DRIVE",
            "address_2": "SUITE 200",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "84098",
            "telephone_number": "800-456-6677",
            "fax_number": "435-776-7281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6849 PEACHTREE DUNWOODY RD NE",
            "address_2": "NE ST. 102 BLDG B1",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303281610",
            "telephone_number": "866-587-9922",
            "fax_number": "678-587-9993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPLEMENTAL HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACOUTOT",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "800-456-6677"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "GA",
            "license": "56131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.