Healthsource Agency Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

RN165113 Issued in GA

Legal business name

HEALTHSOURCE AGENCY INC

Practice address

110 Eagle Spring Dr
Suite D
Stockbridge, GA 30281-2568

Phone

(770) 310-8794

Fax

(678) 961-5719

NPI assigned

May 3, 2009

Last updated

Jan 27, 2017By 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

Mrs. Rufina Noragbon, RN

Title

Director of Nursing

Phone

(770) 310-8794

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1241308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485475200000",
    "number": "1629202874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 EAGLE SPRING DR",
            "address_2": "SUITE D",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302816488",
            "telephone_number": "770-310-8794",
            "fax_number": "678-961-5719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 EAGLE SPRING DR",
            "address_2": "SUITE D",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302812568",
            "telephone_number": "770-310-8794",
            "fax_number": "678-961-5719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE AGENCY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-03",
        "last_updated": "2017-01-27",
        "status": "A",
        "authorized_official_last_name": "NORAGBON",
        "authorized_official_first_name": "RUFINA",
        "authorized_official_title_or_position": "DIRECTOR OF NURSING",
        "authorized_official_telephone_number": "770-310-8794",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "GA",
            "license": "RN165113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "893591747A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2017; 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.