Provider Demographics
NPI:1093142655
Name:EXTENDED HANDS OF GEORGIA
Entity Type:Organization
Organization Name:EXTENDED HANDS OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEATS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-316-1558
Mailing Address - Street 1:5450 LEMOYNE DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-9206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5450 LEMOYNE DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-9206
Practice Address - Country:US
Practice Address - Phone:404-316-1558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1501024654251E00000X, 251G00000X, 343900000X, 347C00000X
GA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle