Provider Demographics
NPI:1447551320
Name:REPRAH ENTERPRISE,LLC
Entity type:Organization
Organization Name:REPRAH ENTERPRISE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:404-246-4544
Mailing Address - Street 1:927 GRANITE SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-5102
Mailing Address - Country:US
Mailing Address - Phone:404-246-4544
Mailing Address - Fax:404-755-7609
Practice Address - Street 1:927 GRANITE SPRINGS LN
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-5102
Practice Address - Country:US
Practice Address - Phone:404-246-4544
Practice Address - Fax:404-755-7609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044016701320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA044016701OtherDHR