Provider Demographics
NPI:1093027641
Name:GEORGIA COMMUNITY PRIVATE HOME CARE SERVICES
Entity Type:Organization
Organization Name:GEORGIA COMMUNITY PRIVATE HOME CARE SERVICES
Other - Org Name:GEORGIA HOME HEALTH CARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IYABO
Authorized Official - Middle Name:OLATUNDE
Authorized Official - Last Name:AKINTOMIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-987-7053
Mailing Address - Street 1:5644 HUNTERS CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-1529
Mailing Address - Country:US
Mailing Address - Phone:770-987-7053
Mailing Address - Fax:770-987-5571
Practice Address - Street 1:5644 HUNTERS CROSSING CT
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-1529
Practice Address - Country:US
Practice Address - Phone:770-987-7053
Practice Address - Fax:770-987-5571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-R-0497253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA207881949AMedicaid