Provider Demographics
NPI:1114782505
Name:PRIVATE HOME CARE PROVIDER LLC
Entity Type:Organization
Organization Name:PRIVATE HOME CARE PROVIDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-273-8545
Mailing Address - Street 1:342 MARIETTA ST NW APT 10
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30313-1645
Mailing Address - Country:US
Mailing Address - Phone:404-273-8545
Mailing Address - Fax:
Practice Address - Street 1:342 MARIETTA ST NW APT 10
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30313-1645
Practice Address - Country:US
Practice Address - Phone:404-273-8545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health