NPIMap

Organization Active NPI

Rehoboth Miracle LLC

Doing business as Rehoboth Miracle Healthcare Services

  • Exclusive Provider Organization
  • Covington, GA
National Provider Identifier
1245519511
Registry record updated Aug 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Exclusive Provider OrganizationTaxonomy code 302F00000X
License
107 R 0894 Issued in GA
Legal business name
REHOBOTH MIRACLE LLC
Doing business as
Rehoboth Miracle Healthcare Services
Practice address
140 Shiver Blvd
Covington, GA 30016-1399
Phone
(678) 712-6073
NPI assigned
Aug 4, 2011
Last updated
Aug 4, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Debrah Olive Ann Ramsay, COLL CERT IND REL
Title
President
Phone
(678) 712-6073

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Exclusive Provider Organization 302F00000X 107 R 0894 GA Primary

Addresses

Primary practice location

140 Shiver Blvd
Covington, GA 30016-1399

Mailing address

140 Shiver Blvd
Covington, GA 30016-1399
Phone (678) 712-6073

Other identifiers 1

IdentifierTypeStateIssuer
107 R 0894OtherGAGEORGIA DEPARTMENT OF COMMUNITY HEALTH

Other names 1

  • Rehoboth Miracle Healthcare Services Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312416000000",
    "number": "1245519511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 SHIVER BLVD",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300161399",
            "telephone_number": "678-712-6073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 SHIVER BLVD",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300161399",
            "telephone_number": "678-712-6073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REHOBOTH MIRACLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-04",
        "last_updated": "2011-08-04",
        "status": "A",
        "authorized_official_last_name": "RAMSAY",
        "authorized_official_first_name": "DEBRAH",
        "authorized_official_middle_name": "OLIVE ANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-712-6073",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "COLL CERT IND REL"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "GA",
            "license": "107 R 0894",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA DEPARTMENT OF COMMUNITY HEALTH",
            "identifier": "107 R 0894",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rehoboth Miracle Healthcare Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Covington, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2011; 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.