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Organization

SUPPLEMENTAL HEALTH CARE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MIKE JACOUTOT (CEO)
(800) 456-6677
Entity
Organization

Contact information

Practice address
6849 PEACHTREE DUNWOODY RD NE, NE ST. 102 BLDG B1, ATLANTA, GA 30328-1610
(866) 587-9922
(678) 587-9993
Mailing address
1640 WEST REDSTONE CENTER DRIVE, SUITE 200, PARK CITY, UT 84098
(800) 456-6677
(435) 776-7281

Taxonomy

Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
56131
GA

Other

Enumeration date
01/16/2007
Last updated
08/22/2020
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