Pride Healthcare Staffing LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

067-R-1905 Issued in GA

Legal business name

PRIDE HEALTHCARE STAFFING LLC

Practice address

3449 Allie Dr
Snellville, GA 30039-7105

Phone

(404) 484-8048

Fax

(770) 686-3109

NPI assigned

Jan 16, 2018

Last updated

Jan 16, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Andrew Mandibaya

Title

Administrator

Phone

(404) 333-5281

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1516060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516060800000",
    "number": "1457869141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3449 ALLIE DR",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300397105",
            "telephone_number": "404-484-8048",
            "fax_number": "770-686-3109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3449 ALLIE DR",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300397105",
            "telephone_number": "404-484-8048",
            "fax_number": "770-686-3109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIDE HEALTHCARE STAFFING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-16",
        "last_updated": "2018-01-16",
        "status": "A",
        "authorized_official_last_name": "MANDIBAYA",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "404-333-5281",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "GA",
            "license": "067-R-1905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Snellville, GA
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• Home Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2018; 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.