Provider Demographics
NPI:1083211833
Name:AID HOMECARE, LLC
Entity Type:Organization
Organization Name:AID HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IVANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-324-1701
Mailing Address - Street 1:5050 UNION STREET
Mailing Address - Street 2:P.O.BOX 309
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291
Mailing Address - Country:US
Mailing Address - Phone:404-400-2237
Mailing Address - Fax:
Practice Address - Street 1:217 ARROWHEAD BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1169
Practice Address - Country:US
Practice Address - Phone:404-400-2237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0OtherNON-MEDICARE