Provider Demographics
NPI:1881296069
Name:PSALM719, INC.
Entity type:Organization
Organization Name:PSALM719, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-248-6215
Mailing Address - Street 1:1628 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-6733
Mailing Address - Country:US
Mailing Address - Phone:912-275-7445
Mailing Address - Fax:912-275-7482
Practice Address - Street 1:1628 UNION ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-6733
Practice Address - Country:US
Practice Address - Phone:912-275-7445
Practice Address - Fax:912-275-7482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care