Provider Demographics
NPI:1164740551
Name:MOBILE HOME HEALTH AIDE SERVICES
Entity Type:Organization
Organization Name:MOBILE HOME HEALTH AIDE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-749-6168
Mailing Address - Street 1:324 SAPPHIRE BND
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-6058
Mailing Address - Country:US
Mailing Address - Phone:404-749-6168
Mailing Address - Fax:
Practice Address - Street 1:324 SAPPHIRE BND
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-6058
Practice Address - Country:US
Practice Address - Phone:404-749-6168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health