Provider Demographics
NPI:1033428289
Name:HOMEFIRST HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:HOMEFIRST HEALTHCARE SERVICES, LLC
Other - Org Name:AVEANNA HEATLHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR REGULATORY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITESIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-248-8740
Mailing Address - Street 1:400 INTERSTATE NORTH PKWY SE STE 1600
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5047
Mailing Address - Country:US
Mailing Address - Phone:770-248-8740
Mailing Address - Fax:
Practice Address - Street 1:805 W. 25TH STREET
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658
Practice Address - Country:US
Practice Address - Phone:704-962-5345
Practice Address - Fax:844-414-3194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0092251F00000X, 251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251F00000XAgenciesHome Infusion
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6602189Medicaid
NC7100661Medicaid
NC3418977Medicaid